Homestead_Dilbeck (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
Jeremy L. Parker Lacie J. Parker
Address(number and street) Address (number and street)
500 E Gibson St. 500 E Gibson St.
City,State and ZIP Code City, State and ZIP Code
Haubstadt, IN 47639 Haubstadt, IN 47639
Country Country
United States of America United States of America
Email Address
-
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
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.
yig ature , rrL Signature of Seiler (�
Prirfted'Name df Seller Date Signed(mmldd/ Printe Name of Sel r Date Signed(mm/dd/yyyy)
Jeremy L. Parker YYYY) Lacie J. Parker 11/26/2024
11/26/2024
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL TH
Buyer 1 -Name as it appears on conveyance document Buyer 2-Name as it appears on c v e do ent
Cole Dilbeck
Address(number and street) Address (number and street) D
n ...1)
9681 W.400 S FL 06 2U
City,State and ZIP Code City, State and ZIP Code 24 ".'
Owensville, IN 47665 C'/ .
Country Country �C0/rQ ,�
k�-�
United States of America .17i 4��
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
FMB•:
E l 0 1. Will this property be the buyer's primary residence? El ❑ 3. Homestead 0�
0 El 2. Does the buyer have a homestead to be vacated for ❑ El 4. Solar Energy Heating or Cooling _?' �-
this res yes, pr
ovide If address: 0 El5. Wind Power Device
Address(number and street) ❑ El 6. Hydroelectric Power Device4k
0 El 7. Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County
A-VI - 31 --3o(- -o0o. 0/1 - OUC .
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
information,SSN/Driver's License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
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