Homestead_Will (2) 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
Matthew C. Clark Hallie J. Clark
Address(number and street) Address (number and street)
12021 E CR 200 S 12021 E CR 200 S
City, State and ZIP Code City, State and ZIP Code
Oakland City, IN 47660 Oakland City. IN 47660
Country Country
United States of America United States of America
Email Address
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.
Sign tur Seller , Sig t e of Seller ���
Printed Name of Seller Date Signed (mm/dd/ Pr to fSme o- Selle Date Signed(mm/dd/yyyy)
Matthew C. Clark YYYY) Hallie J. Clark FI
5/2024
7/5/2024
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL
Buyer 1 -Name as it appears on conveyance document Buyer 2-Name as it appAq`s on conveyance document
Jenna Will Justin Cinciripini ,JUL
Address(number and street) Address (number and street)
604 S Lincoln St. 604 S Lincoln St. tz
Cit . State and ZIP Code City, State and ZIl f U . J4 a)
Y N COUNTY AUDITOR
Fort Branch, IN 47648 Fort Branch. IN 47648
Country Country
United States of America United States of America
Email Address
to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
RI 1. Will this property be the buyers primary residence? 0 ❑ 3. Homestead
�;� •
, 44
❑ IZ 4. Solar Energy Heating or Cooling S
0 0 2. Does the buyer have a homestead to be vacated for 0 IZ 5. Wind Power Device
this residence? If yes, provide address:
❑ tl 6. Hydroelectric Power Device
Address (number and street) ❑ El 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County \tC — I 1 — Ll 0 U ,-O v 0. Q 'l — n 0 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
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