Homestead_Jackson (2) H. PREPARER
•
Preparer of the Sales Disclosure Form Title
Claire Kincaid Settlement Agent
Company
_
4799 Rosebud Lane,Newburgh,IN 47630 -
I. SELLERS)/GRANTOR(S) - ' ;' y
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Charles H. Henderson Joyce Henderson hi i V • A 5
Address(number and street) Address(number and street) ` 10[3
1324 E.Warrenton Rd. 1324 E.Warrenton Rd. ��jj (�
City,State,and ZIP Code City,State,and ZIP Code Qi "' ;
Haubstadt,IN 47639 Haubstadt,IN 47639 SQN •
< 1--
n
Country Country R.4
0/TON
US US
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
property,or omits or falsifies any information required to be provi ed commits a Level 5 felony.
' nature of Seller i nature of Seller
14. A4Alia.i.J -5.zo.,..,L.-R,Lils,__
Pri ted Name of Seller flk SOW(mm/dryyyil. ri Na e of Seller T De Signed(mm/dd/yyyy)
Charles H.Henderson 11/02/2023 v. Joyce Henderson 11/02/2023
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
Emily Elaine Jackson
Address(number and street) Address(number and street)
20110 Barton Rd.
City,State,and ZIP Code City,State,and ZIP Code
Evansville,IN 47725
Country Country
US
for certain deductions.Identify all of those that apply:
YES NO CONDITION ES
NO CONDITION
O 1.Will this property be the buyer's primary y� O 3. Homestead
residence? 0 3 4.Solar Energy Heating or Cooling System
O V2.Does the buyer have a homestead to be vacated 0 ® 5.Wind Power Device
for this residence? If yes, provide address: 0 CZ 6.Hydroelectric Power Device
Address(number and street) 0 ( 7.Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County
4000 -1-3-11-7,00 - 0010. QV, - 024 ,
3
L OPY