Homestead_Carroll H. PREPARER
Preparer of the Sales Disclosure Form Title
Amy B. Pollard Settlement Agent
Company
Address(number and street,city,state,country,and ZIP Code)
7820 Eagle Crest Blvd,Suite 201,Evansville,IN 47715
I. SELLERS)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Amanda N.Moore
Address(number and street) Address(number and street)
503 South Lincoln Street
City,State,and ZIP Code City,State,and ZIP Code
Fort Branch, IN 47648
Country Country
US
( )
Under penalties of perjury,I hereby certify 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 transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Sig atu r Signature of Seller
Printed Nam Her Date Signed(mm/dd/yyyy) Printed Name of Seller e Signed(mm/dd/yyyy)
Amanda N.Moore 04/29/2024 ,f, •,42
J. BUYER($)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS-CIDENTIFYcJyY'A r THAT- '
Buyer 1 -Name as it appears on conveyance document Buyer 2-Name as it on conveyance Q4rrument
Jacob Carroll 0'1' 4 1
Address(number and street) Address(number and street)CO(./=-
723 S Main Street / - 0\
City,State,and ZIP Code City,State,and ZIP Code GO /
izi
Princeton,IN 47670 '0,4
Country Country
US
apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
® 1.Will this property be the buyer's primary ( 0 3. Homestead '
residence? p ® 4. Solar Energy Heating or Cooling System
Y 2. Does the buyer have a homestead to be vacated 0 a) 5.Wind Power Device
for this residence? If yes, provide address: 0 ® 6. Hydroelectric Power Device
Address(number and street) p ® 7.Geothermal Energy Heating or Cooling Device
i
City,State,and ZIP Code County
4L - 1`'t -\9 -(UI - Ooo, 19
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
3