Homestead_Wallace (27) •
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
Joseph Aliu Moses
Address(number and street) Address(number and street)
2843 Vertigo Ct. ./, ' _
City, State and ZIP Code City, State and ZIP Code
Evansville, IN 47715 44,
Country Country j United States of America G'/ . <26+
Email Address
knowingly and intentionally fa a value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony. //i.
Signature of Seiler -x — Signature of Seller
Printed Name of Se erg Date signed(mm/dd/yyyy) Printed Name of Seller Date signe. ��. ayyyy)
Joseph Aliu Moses X 0 f/19)2_67-
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
Laura Wallace
Address(number and street) Address(number and street)
660 N 275 E
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
2 0 1. Will this property be the buyer's primary residence? 0 0 3. Homestead
❑ J 4. Solar Energy Heating or Cooling System
❑ 2 2. Does the buyer have a homestead to be vacated for 0 5. Wind Power Device
this residence? If yes, provide address:
❑ 2 6. Hydroelectric Power Device
Address(number and street) ❑ 2 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county
2 \2-0q103—b0 I. if 2--b2-8 .
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
Page 3