Homestead_Burch H. PREPARER
Preparer of the Sales Disclosure Form Title
Pamela Partenheimer Mick Attorney
Company
Address(number and street,city,state, country,and ZIP Code)
219 N Hart St, PO Box 13, Princeton, IN 47670
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Estate of Virginia R. Tolson
Address(number and street) Address (number and street)
12 Green Acres Road
City,state,and ZIP Code City,state,and ZIP Code
Washington IN 47501
Country Country
daviess
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.
Sign ure f Seller Signature of Seller
Pri d Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Debra Tolson, Personal Representative 09182024
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTPY H •••
' appears on conveyance document Buyer 2—Name as it appears onlolve anl- docmLnt;
Rachel I. Burch Juston L. Jones
Address(number and street) Address(number and street)
504 S Lincoln St 504 S Lincoln St OCT 01 2024
City,state,and ZIP Code City,state,and ZIP Code
Fort Branch, IN 47648 Fort Branch, IN 47648 t-
.14,7-66,70
6IMN punt
GIBSON COUNTY AUDITOR
ify all of those that apply:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary E 0 3. Homestead
residence? 0 4. Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated 0 E 5.Wind Power Device
0 0 for this residence?If yes,provide address: 0 E 6. Hydroelectric Power Device
Address(number and street) r] Ci 7. Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
' / 9 _ /o/ 7 od, 7 5 _ c
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
transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
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