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Preparer of the Sales Disclosure Form Title
Matthew Jarvis Escrow,Officer
Company E-mail address
Southwestern Indiana Land Title matt@swinland.com
Address (number and street, city, state, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
. L.CI[t0l1%JMAN I UK(b)
Seller 1 - Name as it appears'on conveyance document
Kathryn Louise St. Clair, by Susan E. Burke, her attorney -in -fact
Address (number and street)
7500 Syls Dr.
City, State and ZIP Code
Evansville, IN 47712
Country
i
United States of America
E
Telephone number
'812) 425-0055
Seller 2 - Name as it appears on conveyance document
Haaress (number and street)
Uly, Mate and ZIP Code
L,ountry
mail Address Telephone Number I Email Address
4 g1-:?- 9'8-S--/5Y6
Telephone Number
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.
Signatur of Seller ,
Printed Name of Seller
Signature of Seller
igned (mm/dd/AxF Printed Name of Seller
Kathryn Louise St. Clair, by Susan E. yyyy)
Burke, her attorney -in -fact 6/12/2026
J. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL THAT PL
Buyer 1 - Name as it appears on conveyance document Buyer 2 -Name as it appears on
Jessica Moore
Address (number and street) i Address (number and street)
617 S Main St.
City, State and ZIP Code City, State and ZI$
Owensville, IN 47665 t C a
O
Country Country
United States of America
Email Address Telephone Number 1 Email Address
2026
O
Date Signed (mm/dd/yyyy)
Telephone Number
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
0 ❑ 1. Will this property be the buyer's primary residence?
❑ 0 2. Does the buyer have a homestead to be vacated for
this residence? Ifiyes, provide address:
Address (number and street)
City, State, and ZIP Code
County
YES NO CONDITION
0 ❑ 3. Homestead
❑ 0 4. Solar Energy Heating or Cooling System
❑ 0 5. Wind Power Device
❑ 0 6. Hydroelectric Power Device
❑ 0 7. Geothermal Energy Heating or Cooling Device
d,(D-1-7- ta- l0\-00CD, 330-00-Q,
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.)
/Signature of Buyer 1 C
e
Printed Legal Name of Buyer 1
Jessica Moore
Signature of Buyer 2/Spouse
Sign Date (MM/DD/YY) Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
6/12/2026
�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
SSN: --1 01-1F5 q XVnL .1 /aQ
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