HomeMy WebLinkAboutHomestead_WestH. PREPARER
Preparer of the Sales Disclosure Form
Title
Abbigail Jarvis
Escrow Officer
Company
E-mail address
Telephone number
Southwestern Indiana Land Title
abby@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
1. SELLER(S)/GRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as it appears on conveyance document
Abner Homes and Contracting LLC, an Indiana Limited Liability
Company
Address (number and street)
Address (number and street)
8572 West SR 65
City, State and ZIP Code
City, State and
ZIP Code
Hazleton, IN 47640
i
i
Country
Country
United States of America
Email Address
Telephone Number
Email Address
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.
aSigaatMoSep
Signature of Seller
Printed Nalfie of Seller
Date Signed (mm/dd/
Printed Name of Seller Date Signed (mm/dd/yyyy)
Derek Abner, Managing Member
yyyy)
6/29/2026
J. BUYER(S)/GRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS
— IDENTIFYIALL THAT APPLY
Buyer 1 — Name as it appears on conveyance document
Buyer 2 — Name as it apK ocument
Johnathan Douglas West
t�VT
Address (number and street)
Address (number and st et)
400 N Hull St
City, State and ZIP Code
Fort Branch,
City, State and !ZIP Code
IN 47648
Country
Country O
/
United States of America
CVO
Email Address
Telephone Number
Email Address
Telephone Number
JohnathanwestOl @gmail.coom
(618) 263-2183
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
❑ 1. Will this property be the buyer's primary residence?
K ❑ 3.1, 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:
❑ 10 5. Wind Power Device
❑ 0 6.1 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/IDOOther Number is necessary if a Homestead Deduction is being filed.)
"Signature of Buyer 1
Signature of Buyer 2/Spouse
41
Printed Legal Name of Buyer 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Johnathan Douglas West 7/1/2026
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: & Hq()-Tlv,0,4m 9,61,577
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