Homestead_Johnson (28) 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
Gary Clark Kimberly Clark
Address(number and street) Address(number and street)
1614 Brentwood Dr. 1614 Brentwood Dr.
City,State and ZIP Code City, State and ZIP Code
Princeton, IN 47670 Princeton, IN 47670
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.
Si natu Seller 0 4..._ ,Si na r of Seller
Printed Name of Se er Date Signed (mm/dd/ Pr'n( ted Name oiler Date Signed(mm/dd/ri Y)
g Y
Gary Clark YYYY) Kimberly Clark 7/17/2024
7/17/2024
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT APPLY
111.
Buyer 1 —Name as it appears on conveyance document Buyer 2—Name as it appears on conveys -d cu
Yvonne Johnson Christian Magnolia Simmons
Address(number and street) Address(number and street) 1V 0 1
1614 Brentwood Dr. 1614 Brentwood Dr. 9,`A 2024
City, State and ZIP Code City, State and ZIP Code 0"
Princeton, IN 47670 Princeton, IN 47670 [,�
Country Country Q':ti PU t^ pR
United States of America United States of America G�tt COUN
Email Address .
YES NO CONDITION YES NO CONDITION
Et ❑ 1. Will this property be the buyer's primary residence? RI El 3. Homestead
El RI 4. Solar Energy Heating or Cooling Sy
Vei El 2. Does the buyer have a homestead to be vacated for El p 5. Wind Power Device ;Q
this residence? If yes, provide address:
❑ El6. Hydroelectric Power Device
A
Address(number and street) ❑ I l 7. Geothermal Energy Heating or Cooling Device 4f
1-1310 Was Sr6 n Ave it
City,State,and ZIP Code County
Eva istri/&, IN '177/5- VaithA -/ 4aQ-4of._aoa.., .3(01 Dag
Under penalties of perjury,I hereby certify that this Sales Disc osure,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.(Note:Both spouse's