Homestead_Garner H. PREPARER
Preparer of the Sales Disclosure Form Title
Matthew Jarvis Escrow Officer
Company
Address (number and street, city, state, country, and ZIP code) FIL
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713I. SELLER(S)/GRANTOR(S)
Et D
Seller 1 -Name as it appears on conveyance document Seller 2-Name as it appears on conveyance documen
Dakota Ritchey Shelby Forston AU(i 2 9 2023
Address(number and street) Address(number and street) (._)\
5894 S 100 E 5894 S 100 E City, State and Z Code ZIP
.1/ ��
IP
Fort Branch, N47648 Fort Branch IN47648�IBSON COON gl'DtR
�"' ?d)
o
Country
ry
United States of America United States of America
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.
.Signal eller / .vSignpttire,of Seller
AS
Printed ame of Seller Date signed (mm/dd/yyyy) Printed Nan of Seller Date signed(mm/dd/yyyy)
Dakota Ritchey 8/21/2023 Shelby Forston 8/21/2023
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
Jeffrey A. Garner Rhonda D. Garner
Address(number and street) Address(number and street)
2763 Knoll Top Lane 2763 Knoll Top Lane
City, State and ZIP Code City, State and ZIP Code
Henderson, KY 42420 Henderson, KY 42420
Country Country
United States of America United States of America
Email Address
Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
El 0 1. Will this property be the buyer's primary residence? El ❑ 3. Homestead
0 El 4. Solar Energy Heating or Cooling System
0 El 2. Does the buyer have a homestead to be vacated for 0 El 5. Wind Power Device
this residence? If yes, provide address: 0 El 6. Hydroelectric Power Device
Address(number and street) 0 El 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county
6- (q- D -,,2.19& - . 6-7Q- oar
Under penalties of perjury, I hereby certify that 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. (Note:Both spouse's
' Q7iiiPage 3 pyc1