HomeMy WebLinkAboutHomestaed_MoonH. PREPARER
Preparer of the Sales Disclosure Form
Title
Matthew Jarvis
Escrow Office
Company
E-mail address
Telephone number
Southwestern Indiana Land Title
matt@swinland.com
(812) 425-0055
Address (number and street, city, state, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard Evansville IN United States of Amenca 47713
I. SELLER(S)/GRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as it appears on conveyance document
Shalonda Maree Newcomb
John Lawrence Perkins
Address (number and street)
Address (number and street)
913 Mohawk Dr.
913 Mohawk Dr.
City, State and ZIP Code
City, State and ZIP Code
Fort Branch, IN 47648
Fort Branch, IN 47648
Country
Country
United States ofAmerica
United States ofAmedca
Email Address
I.Telephonp Number
Email Address
Telephone Number
h
8 o 664 n
Untler pe so perjury, I hereby certify this Sales Disclosure, to the best of my knowledge and belief, is true, correct, and complete as required
bylaw, d Is repared In accordance with IC 6-1.15.5. A person who knowingly and intentionally falsifies the value of transferred real property, or
omits far ' any Information re#plmdtobe provide commits a Level 6 felony.
Sign
S r
tof
Sign of
Printed a of Seller
Date Signed (mm/ddl
nrded Name of Seller Date Signed (mmldtl/yyyy)
Shalonda Maree Newcomb
YYYY)
John Lawrence Perkins 4/14/2026
4/14/2026
J. BUYER(S)IGRANTEE(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 cloaftt
Jillian C. Moon
Daniel A. Moon
Address (number and sheet)
Address (number and street)
807 Creek Dr
807 Creek Dr
City, State and ZIP Code
City, State and ZIP Code C,
Fort Branch, IN 47648
Fort Branch, IN 47648
Country
Country OO 026,
United States ofAmerica
United States of America 4Q
Email Address
Telephone Number
Email Address hone Number
(812) 881-1977
AS,
) 632-1494
Pursuant to IC 6.1.142.44, the Sales Disclosure Form may be used to apply
for certain deductions. Identify all of those that aw.
YES NO CONDITION
YES NO CONDITION
0 ❑ 1. Will this roe be the bu ees rime residence?
0 ❑ 3. Homestead
O ® 0. Solar Energy Heating or Cooling System
❑ 2. Does the buyer have a homestead to be vacated for
this residence? if yes, provide address:
❑ 0 5. Wind Power Device
❑ 0 6. Hydroelectric Power Device
Address (number and street
^ t
❑ 0 7. Geothermal Energy Heading or Cooling Device
City, State, and ZIP Code County
oZ(v-19-18-101-001.119a-:oRCQ
ZagUnder
penalties of perjury, I hereby certify that this Sales Disclosure, to the beat of my knowledge and belief, is true, correct, and complete as
required by law, and is prepared In accordance with IC B-1.1-5.6. 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/Orlver's
IlcenseND/Other Numberis neeessaryifa Homestead Deduction is belno Aled.1
ignal
uyer'L,Signa
of Bu r S se
Pnn Legal Name of Buyer 1 Sign Date (MM/DD/1'Y)
Printed Legal Name of Buyer 2/Spouse Sign Date (MMIDDIYY)
JilliOYC. Moon 4/142026
Daniel A. Moon 4/14/2026
ast 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number
Last 5 Digits of Buyer 218pouse SSN/Dnver's License/ID/Other Number
SSN: $ �-Xy D41 one lgq7qSSN:
$`6`1q eC "N % 0 #7
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