Homestead_Ross (2) H. PREPARER
Prnponerof the Sales Disclosure Form Title
Escrow Officer
Matthew Jarvis
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)0GRANTOR(S)
Seller 1 -Name aod appears on conveyance document Seller 2-Name ma |t appears ance document
John D. Potts
Address (number and street) Address (number and street)
1272VKChukorHn|w
� /�r
Cd8State and ZIP Code Cit� Sh�eand ZIP Code ��e /9� �v�^
Houbotmdt. |N 47838
Country Country ^
United States ofAmerica
Email ' '
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
hy law,and iy prepared in accordance with|C 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.
| Signature ofSeller
Ph-��«�'m-- 'e of e||or Date Signed Vnmmd/ Printed Name ofSeller Date Signed(mmmu/yvyy
John D. Potts yyyy/
11/22/2O24
J. BUYER(S)AG&&NTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1 -Name auit appears on conveyance document Buyer 2-Name aoit appears on conveyance document
ScottG. Ross StacyL Ross
Address(number and street) Address(number and street)
211 Writers Rd 211 Winters Rd
City, State and ZIP Coda City, State and ZIP Coda
Linton, IN 47441 Linton, IN 47441
Country Country
�
United States ofAmerica United States ufAmerica
Email Address
apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
[Q O 1. Will this property be the buyers primary residence? 2 O 3. Homestead
-^� y] 2. Does the buyer have a homestead tobe vacated for [] G] 4. Solar Energy HaaUngor Cooling System
~ this residence? |f yes, provide address: O [0 5. VWnd Power Device
Address(number and street) O GO G. Hydrua|eothuPower Device
All vifW� Rd O [21 T' Geothermal Energy Heating
or Cooling Device
City, State,and ZIP Code
� -County
� | @ ��n 4V�� -TA1 '4 7qql 6r�n -u0[ - J ]2- '" 2_ ]-b
Under penalties of perjury,| hereby certify that this Sales Disclosure,to the best ofmy knowledge and belief,ia true,correct,
'and comp
lete
as required by law,and is prepared in accordance with IC 64.1'5.5.A person who knowingly and intentionally falsifies the value of
transferred real poopo��'wr omits nrfalsifies any information required tpbe provided,commits o Level 6 felony. yxmmo:Both spouse's
6 /s /f Homestead Deduc�onisbe/ng0VedJ
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