Homestead_Harvey (7) 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) FIED
Seller 1 —Name as it appears on conveyance document Seller 2—Name as it appears on convet
Lorinda D. Barrell Kevin A.Tate
Address (number and street) Address(number and street) SEP 2 5 2023
3437 S 125E 11125 N. Madison Avenue
City, State and ZIP Code City, State and ZIP Code
Princeton, IN 47670 Kansas City, MO 64155 Cit33�a l/�2`,ex ,
Country Country N�DUNTY AUDITOR
United States of America
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&_,A4info ation required to be provided,commits a Level 5 felony.
xi nature o .eller ,i nature of Seller I
Print era e of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signe (mm/dd/yyyy)
Lorinda D. Barrell 9/14/2023 Kevin A.Tate Xt //a/av '3
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
Lance Harvey
Address (number and street) Address(number and street)
219 W. Pine St.
City, State and ZIP Code City, State and ZIP Code
Princeton, IN 47670
Country Country
United States of America
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? ❑ 0 3. Homestead
❑ El 4. Solar Energy Heating or Cooling System
0 2 2. Does the buyer have a homestead to be vacated for 0 El 5. Wind Power Device
this residence? If yes, provide address:
❑ El 6. Hydroelectric Power Device
Address(number and street) 0 El 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county
c96 — la-og - 9oa - oo2 . 3119 -0a5
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct and complete
COPY