HomeMy WebLinkAboutHomestead_Kenworthy 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
Dee Ann Parker -I
Address (number and street) Address (number and street)
104 N. Walters St.
City, State and ZIP Code City, State and ZIP Code
Fort Branch, IN 47648 '`',1,. ,/,: ‘,. .
Country Country
United States of America C
Email Address
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of
Under penaltie -perjury, I hereby ce fy th Sales Disclosure, to the best of my knowledge and b°4s true, cor� and co etc as required
who knowingly and intentionallyfalse value of4t'ansferred real property, or
by law, and ' prepared in�cdrdance With I¢ 6-1.1-5.5. A person g y
omits or falsifies any information regMired t6 be provided, commits a Level 5 felony. 'l/
iti
ign ture of Sell /r Signature of Seller '9G'
--F//t1(-/ 0 •
Printed ame of Seçt1%1
r Date Signed (mm/dd/ Printed Name of Seller O,A Date Signed (min/dd/yyyy)
Dee Ann Parker yyyy)
2/13/2026
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
Jamie Kenworthy
Address (number and street) Address (number and street)
803 E. Walnut St.
City, State and ZIP Code
City, State and ZIP Code
Fort Branch, IN 47648 _
Country Country
United States of America ,
Email Address
certain deductions. Identify all of those that apply:
YES NO CONDITION
YES NO CONDITION 4;i
f primaryresidence? ❑ 3. Homestead , '
1. Will this property be the buyer's ,�,-�
❑ P P Yto
❑ 2. Does the buyer have a homestead to be vacated for El 04. Solar Energy Heating or Cooling Sys m
this residence? If yes, provide address: 0 El 5. Wind Power Device
D Z 6. Hydroelectric Power Device
Address (number and street)
❑ 0 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County r I
2 . l 1 - 3 o3 -pco . 3)--S — 0
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