Homestead_Doty 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 TT
1 1
I. SELLERS)/GRANTER(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as it appears on conveyance
Brooke Allen Lance Allen
Address(number and street) Address(number and street) SEP 0 6 2023
106 N Hull St. 106 N Hull St.
City, State and ZIP Code City, State and ZIP Code
Haubstadt, IN 47639 Haubstadt, IN 47639 G►BSONCOV�y-'a-16;
141)
Country Country AuDiron
United States of America United States of America
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 f lony.
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P ed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed (mm/dd/yyyy)
Brooke Allen 8/24/2023 Lance Allen 8/24/2023
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1 -Name as it appears on conveyance document , iyer 2-Name as it appea on conveyance document
Brenda K. Doty Hayley Nicole Doty
Address(number and street) s reet)
1438E 1200 S .,1,-1-r,-NU
City, State and ZIP Code City, State and ZIP Code
Haubstadt, IN 47639
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
C11.41
El 0 1. Will this property be the buyer's primary residence? 2 ❑ 3. Homestead
❑ ii 4. Solar Energy Heating or Cooling S '-
0 2 2. Does the buyer have a homestead to be vacated for ❑ p 5. Wind Power Device k.
this residence? If yes, provide address:
❑ Il 6. Hydroelectric Power Device
Address (number and street) 0 2 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county J 3 6,40
�6- 8 Z -OOO. 3 15' -OOC
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
j Buyer 1 -Name as it ap ars on conveyance document Buyer 2-Name as it appears on conveyance document
Jacob Garland Brown
reet) Address (number and street)
-1 ll S. ALiint c1JCi.
City, State and ZIP Code City, State and ZIP Code
, IN
Country Country
for certain deductions. Identify all those that apply:
YES NO CONDITION YES NO CONDITION
0 ❑ 1. Will this property be the buyer's primary residence? 0 ❑ 3. Homestead
❑ RI 4. Solar Energy Heating or Coolin : :�
❑ ICJ 2. Does the buyer have a homestead to be vacated for 0 l 5. Wind Power Device
this residence? If yes, provide address:
❑ IZ 6. Hydroelectric Power Device
Address (number and street) 0 IZ 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county
�6- t8 - 3 6- ant - 000. — oo1I
- 11-
❑