HomeMy WebLinkAboutHomestead_Ray (2)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
Richard Georges
Address (number and street)
Address (number and street)
3162 S 650 E
City, State and ZIP Code
City, State and ZIP Code
Francisco, IN 47649
Country
Country
United States of America
Email Address
Telephone Number
Email Address
Telephone Number
12 q '3 1-:5-) -) S
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.
ignaturSelle
Signature of Seller
Printed Name of Seller
Date Signed (mm/dd/
Printed Name of Seller Date Signed (mm/dd/yyyy)
Richard Georges
yyyy)
4/16/2026
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 conveyan cument
Blake D. Ray
o
0
Address (number and street)
Address (number and street) C
3298 W Mary Roberts Dr.
<
City, State and ZIP Code
City, State and ZIP Code
cv
D0
Princeton, IN 47670
Country
Country
United States of America
rT 0
Email Address
Telephone Number
Email Address
Telephone Numbe
BlakeDRay420@yahoo.com
(812) 677-8132
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
0 0Will this property be the buyer's primary residence?
0 ❑ 3. Homestead
0 0 4. Solar Energy Heating or Cooling System
®1.
❑ 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)
❑ 0 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP 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/Driver's
License/ID/Other Number is necessary if a Homestead Deduction is being riled.)
Si natu a of Buy . 1
Signature of Buyer 2/Spouse
Printed Legal Name of Buyer 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Blake D. Ray 4/16/2026
ast 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
sN: &6)l 41 2V 0Z' 17"17v
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