Homestead_Rogers 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)
Seller 1 -Name as it appears on conveyance document Seller 2- Name as it appears on conveyance document
Anthony D. Rogers Jane Ann Rogers
Address(number and street) Address (number and street)
4970 N Old Hwy 41 4970 N Old Hwy 41
City, State and ZIP Code City, State and ZIP Code
Patoka, IN 47666 Patoka, IN 47666
Country Country
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 ny information required to be provided,commits a Level
f
i na r f ign t f S er�
Printed Name of S er p.1,.••-•Date signed (mm/dd/yyyy) /ri ed Name of Seller Date signed (mm/dd/yyyy)
Anthony D Roge 1/12/2023 (J neAnn Rogers 1/12/2023
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 veyance document
Zachary Carleton Rogers
Address (number and street) Address (number and street)
4970 Old Hwy 41 N si4
City, State and ZIP Code City, State and ZIP Code 414/
Patoka, IN 47666 _ `in
Country Country Q4s,, ,, 40
United States of America
Email Address
apply for certain deductions. Id'rjj II of those that apply:
YES NO CONDITION YES NO CONDITION
RI 0 1. Will this property be the buyer's primary residence? RI 0 3. Homestead
❑ RI 4. Solar Energy Heating or Cooling System
0 RI 2. Does the buyer have a homestead to be vacated for 0 RI 5. Wind Power Device
this residence? If yes, provide address: ❑ RI 6. Hydroelectric Power Device
Address (number and street) 0 El 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county
c77 =d1-1- 13 -3a)- oco.0-7ti - 0(73
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
_'