HomeMy WebLinkAboutHomestead_Cox (4)H. PREPARER
Preparer of the Sales Disclosure Form
Title
Matthew Jarvis
Escrow Officer
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 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
Shawn Crisler
Address (number and street)
Address (number and street)
2164 S 1200 E
City, State and ZIP Code
City, State and ZIP Code
Oakland City, IN 47660
Country
Country
United States of America
Email Address
Telephone Number
Email Address S�
lephone Number
shawncrisler@gmail.com
(765) 369-6524
tic
1 C), C;�>
T
Under penalties of perjury, 1 hereby certify this Sales Disclosure, to the best of my knowledge and belief, is tct, 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 v ansferred real property, or
omits or falsifies any information required to be provided, commits a Level 5 felony. O��
Signature o e ler
Signature of Seller
Printed Name of Seller
Date Signed (mm/dd/
Printed Name of Seller Date Signed (mm/dd/yyyy)
Shawn Crisler
yyyy)
4/24/2026
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
Jacob E. Cox
Kennedy L. Cox
Address (number and street)
Address (number and street)
1234 E 150 S
1234 E 150 S
City, State and ZIP Code
City, State and ZIP Code
Princeton, IN 47670
Princeton, IN 47670
Country
Country
United States of America
United States of America
Email Address
Telephone Number
Email Address
Telephone Number
(812) 664-4176
(812) 779-7691
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
i 0 ❑ 1. Will this property be the buyer's primary residence?
0 ❑ 3. Homestead
❑ 0 4. 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
❑ Z 6. Hydroelectric Power Device
Address (number and street)
1 i &;b q C—_ ' =5 Q 5
❑ 0 7. Geothermal Energy. Heating or Cooling Device
City tate, and 7 Code County
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/Drivers
License/ID/Other Number is necessary if a Homestead Deduction is being tiled.)
Sign Lure of Buyer 1
Signature of Buyer 2/Spouse
Printed Legal Name of Buyer 1 Sign Date (MM/DD/YY)
Printed Legal Nam of Buyer 2/Spouse Sign Date (MM/DDNY)
Jacob E. Cox 4/24/2026
Kennedy L. Cox 4/24/2026
Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
SSN: yj$8 _Zt/ OL ; 3
SSN: L ; S
Page 3