Homestead_Koberstein (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 conveyance document
Ronald W. Wilson, Personal Representative of the Unsupervised
Estate of Robyn A.Wilson,deceased
Address(number and street) Address(number and street) A ED
4865 E. Carithers Road
City, State and ZIP Code City, State and ZIP Code
Princeton, IN 47670
Country Country MAPAF 8 2024
United States of America
Email Address
.� s e f N Y AUDITO
AIRSON COU 'TY ,
Under penalties of perjury, I hereby certify this Sales Disclosure,to the best of my knowledge and belief, is true,correct and complete
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.
xSignaNe oq ielOri / /4 ek /e,) Signature of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Ronald W. Wilson, Personal Represntative 3/5/2024
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
Jacob M Koberstein
Address(number and street) Address(number and street)
4865 E Carithers Rd.
City, State and ZIP Code City, State and ZIP Code
Princeton, IN 47670
Country Country
United States of America
Email Address
certain deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
0 ❑ 1. Will this property be the buyer's primary residence? 0 El 3. Homestead
❑ 0 4. Solar Energy Heating or Cooling System
0 0 2. Does the buyer have a homestead to be vacated for 0 0 5. Wind Power Device
this residence? If yes, provide address:
❑ 0 6. Hydroelectric Power Device
Address(number and street) ❑ 0 7. Geothermal Energy Heating or Cooling Device
City, State, ZIP code, and county
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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