Homestead_Roberts (9) 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 onveyance document
Janette Johnson
Address (number and street) Address (number and street)
6248 S State Road 165
City, State and ZIP Code City. State and ZIP Code D� '4,6
Owensville, IN 47665 O?
Country Country Ql 6'
United States of America "TSp ?Otf'
Email Address
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Under penalties of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge and belief, is tri14ct, 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 vatf transferred real property, or
omits or falsifies any information required to be provided, commits a Level 5 felony. �''YY
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Signature of Ier Signature of Seller
Printed Name , Seller ' Date Signed (mmldd/ Printed Name of Seller Date Signed (mm/dd/yyyy)
Janette Johnson YYYY)
12/16/2025
J. BUYER(S)/GRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL THAT APPLY
Buyer 1 - Name as it appears on conveyance document Buyer 2 - Name as it appears on conveyance document
Blake Roberts Jeffrey Roberts
Address (number and street)` % --b h Address (number and street)
4280 County Road 450 West 4280 County Road 450 West
City, State and ZIP \-/VCA City, State and ZIP Code
Owensville, IN 47665 Owensville, IN 47665
Country ( yf,,, Country
United States of America e United States of America
Email Address
deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
2 ❑ 1. Will this property be the buyer's primary residence? V 3. Homestead
J Fi 2. Does the buyer have a homestead to be vacated for LI 0 4. Solar Energy Heating or. C,po ng stem
this residence? If yes, provide address: ❑ El 5. Wind Power Device
Address (number and street) •
❑ 0 6. Hydroelectric Power Device
❑ RI 7. Geothermal Energy Heating or CoolingA Device
-Y'
City, State, and ZIP Code County 2-6 1-1- 049--y00 - 001 . 1t4 -021 ,
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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.)
3