Homestead_Cummins H. PREPARER
Preparer of the Sales Disclosure Form Title
Matthew Jarvis Escrow Officer
Company
Address(number and street, city, state, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
I. SELLER(S)/GRANTOR(S) j.:111Zerk,Seller 1 -Name as it appears on conveyance document Seller 2-Name as it a ears on conve aPP Ye
Kathy Mae Kirsch Richard Carroll Stocke
Address(number and street) Address(number and street) AUV
1108 CR 675E 3511 Meadow Bluff Way 4
, ?023
City,State and ZIP Code City, State and ZIP Code
Carmi,
Country IL
62821 Country Louisville, KY 40245 C'/BSON`O/..Q�Ty �
United States of America United States of America qV0/
Email Address
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief, is true,correct and complete as
required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Signature of Seller ' ,�6ignatur / SeIJ�r D 7 jJ'2
>! am Yin I'N✓�,- ) /f 2vT.-+C��(
Printed Name ctSeller Date ign d(mm/dd/yyyy) Printedd'"Name of Seller pate signe (mm/dd/yyyy)
Kathy Mae Kirsch if 8(2 J Richard Carroll Stocke X O JO9/2 y3
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1 -Name as it appears on conveyance document Buyer 2-Name as it appears on conveyance document
Kyle Cummins Kelsey Cummins
Address(number and street) Address(number and street)
1980 N. Old Petersburg Rd. 1980 N. Old Petersburg Rd.
City,State and ZIP Code City, State and ZIP Code
Princeton, IN 47670 Princeton, IN 47670
Country Country
• United States of America United States of America
orr
YES NO CONDITION YES NO CONDITION
el
❑ 1. Will this property be the buyer's primary residence? � 0 3. Homestead
p0 RI 4. Solar Energy Heating or Cooling System
O ll 2. Does the buyer have a homestead to be vacated for 0 p 5. Wind Power Device
t this residence? If yes, provide address:
p ❑ RI 6. Hydroelectric Power Device
Address(number and str et 0 0 7. Geothermal Energy Heating or Cooling Device
ctl
City, State,ZIP code, and IAA county - L
P' - Do - �1�6a-o 26-11- to too -oo o . �q� o2?_ .
0 Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct and complete
1 as required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the value of
transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
information, SSN/Driver's License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
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