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Homestead_Atkins (3) H. PREPARER
Pnepererofthe Sales Disclosure Form Td|a
Matthew Jarvis Escrow Officer '
Company
Address (number and mdnant, city, obo\e, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
|. SELLER(S)/GRANTOR(S)
Seller -Namooa it appears on conveyance document Seller 2-Name as it appears on conveyance document
Stacy Russell
Address (number and street) Address (number and street)
1O070E State Road G4 J�'r
City, State and ZIP Code City. State and ZIP Code +� '
Oakland City, IN 47060 .
Country Country /)n~
°�/ �
United States ofAmerica
Email Address
cfmy knowledge and belief, is Yo� complete as
e 4
required who eoftransferred
real property,or omits ur falsifies any information required tobo provided, commits u Level sfelony. `'o�-
~,"�zignaUuna of Selle Signature of Seller
/V
ld
Phn0ndName ofAeller ' Date Signed (mmmu/ Printed Name ofSeller Date Signed (mm/ u/yvyv)
Stacy Russell YYYY) ,
1U/1O/2O24
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1 -Name oah appears nn conveyance document Buyer 2-Name uod appears on conveyance document
Wade Atkins AhannaKXorho J
Address (number and atnee� Addnaas (numbermndstree� ~--�
1UO7OES�ato �oadO4 m
�OO7UES�a�oRnad84 ����� �v.-
City. State and ZIP Code City. State and ZIP Code
Oakland City, IN 47660 Oakland City, IN 47650 ^�~
Country Country
United States ofAmerica United States ufAmerica
Email Address ,
~'� ` ' " � ' '-- -
Punouantto |CV4.14%'44.thoSo|ooDinc|onureFonnnnoybeuoodbxopp|yforoertuindnductions |dunUfyaUofthosudhatapp|y:
YES NO CONDITION YES NO C[)N0T|C)N
25 O 1, Will this property bo the buyer's primary residence? B] O 3. Homestead
O Z 4. Solar Energy Heating or Cooling System
El /2. Does the buyer have o homestead 8» be vacated for O E] 5. VWndPower Dovico
this residence? If yes, provide' � O 2 G. Hydroelectric Power Device
Address(number and street) O M 7. Geothermal Energy Heating or Cooling Device
City, State. and ZIP Code County
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true, correct, arid 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 .
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