Homestead_Cox (4) H. PREPARER
Pnnponarof the Sales Disclosure Form Title
Matthew Jarvis Escrow Officer
Company
Address (number and street, ohty, state, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47718
|. SELLER(S)/GRANTOR(S)
Seller 1 -Name asit appears un conveyance document Seller 2-Name aui m oznce document
Christian |. Harper �
Address (number and street) Addneno/numberand street)
831 N Main St.
City, State and ZIP Code City, State and ZIP Code
'^ /T "�� J��, /
Oakland City, IN 47680 . �w��
Country Country
United States ofAmerica E-mail address
of my knowledge and belief, is true, correct and complete as
required by law
prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the value of transferred
eal pro "r6itu or falsifies any infor 'Uon required to be prnvidod,commits a Level sfo|ony.
|or Signature of Seller r
«�~~edNemeofSo||er Date signed (mrn/dg/yyyy) Printed Name ofSeller Date signed (mn/ud/yyyy)
Christian 1. Harper 4/18/2023
J. BUYER(S)x3RANTEE(S)-APPL|CAT|ON FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1 -Name as it appears on conveyance document Buyer-Name an it appears on conveyance document
Terrell Cox
Address (number and street) Address (number and street)
917 N Main St
|
City, State and ZIP Code City, State and ZIP Code
Oakland City, |N47GOO .
! Country Country
.United States ufAmerica
I'D E-mail address
for certain deductions. Identify al hose that apply:
YES NO CONDITION YES NO CONDITION �
' E1 O 1. Will this property ba the buyer's primary residence? z O 3. Homestead
O Z 4. Solar Energy Heating orCnoling
` B O 2. Does the buyer have a homestead tobe vacated for U Gg 5 Wind
this residence? If yes, provide address: �
O E5 G. Hydroelectric Power Device
r� Address (number and street) O GO 7. Geothermal Energy Heating or Cooling Device
' 817 N Main St
7 City, State,ZIP code, and county
�rOakland City, |N47OO Gibson
/ undorponauiosofpo�ur� | »enobvoadipydhatthia8a|osoiuu|osuro'tuthobaatofmyhnow|pdgoandhoxo� isuoa. 00rnoctandoomp|ota
-~ i u b | u i prepared in accordance |�n 1 1~s a xporsonwho knowingly and intentionally the o�
r� as required y law, s ' � . �
transferred real property,nromits or falsifies any information required to be provided,commits a Level s felony. (Note:Both spouse's