Homestead_Ash (3) 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 convey ocument
Jesse M. DMellow
Address(number and street) Address (number and street)
406 N Hull St. ,/.Q� <,(24/40\>
Y rCity, State and ZIP Code City, State and ZIP Codfa,Fort Branch, IN 47648CountrCountry Y — ��,
United States of America j'
Email Address
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 felony.
Signature of Seller �� Signature of Seller
/�
Printed Name Seller Date signed (mm/dd/yyyy) Printed Name of Seller Date signed (mm/dd/yyyy)
Jesse M. DMellow 1/26/2024
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
Lane Carl Ash
Address (number and street) Address (number and street)
205 E 800 S
City, State and ZIP Code City. State and ZIP Code
Fort Branch, IN 47648
Country Country
United States of America
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YES NO COND
ITION YES NO CONDITION re °;t^'j
E 0 1. Will this property be the buyer's primary residence? 0 0 3. Homestead
0 I l 4. Solar Energy Heating or Cooling System 4froj
::
0 /2. Does the buyer have a homestead to be vacated for 0 p 5. Wind Power Device
this residence? If yes, provide address:
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 l (. —1C, _1 g_ 3o),, Q0Q 3(6, I_ o 6
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct and complete
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