Homestead_Jones (11) 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 doc ent
Mary Key
Address(number and street) Address(number and street)
(o'1 L' (A) Polpla� �,rC
City, State and ZIP Code City, State and ZIP Code 0"
IN sTrt, {t-,N -1-N., . 1t_:1c, �!
Country Country O'�6s I
United States of America O4/r, ��cr
Email Address `-
of my knowledge and belief, is true,correct a lete as
required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the v u transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony. 7"
Sig f r Signature of Seller �y rted�J-g%$
/`Printed erne of S�Net� � Date signed(mm/dd/yyyy) Printed Name of Seller Date sig m/dd/yyyy)
Mary Key 11/2/2023 I
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
David F. Jones Gracy M. Jones
Address(number and street) Address(number and street)
5329 N 550E 5329 N 550 E
City, State and ZIP Code City, State and ZIP Code
Patoka, IN 47666 Patoka, IN 47666
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 41';"
El ❑ 1. Will this property be the buyer's primary residence? 2 ❑ 3. Homestead
❑ El 4. Solar Energy Heating or Cooling Syst fi
❑ 2. Does the buyer have a homestead to be vacated for ❑ p 5. Wind Power Device
this residence? If yes, provide address: �A.. '
0 El 6. Hydroelectric Power Device ¢ -,
Address(number and street)
0 0 7. Geothermal Energy Heating or Cooling Device,'
`
City, State,ZIP code, and county
a64- 12-1-100 — 00( .00 - -02A- •
-
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete