HomeMy WebLinkAboutHomestead_Martin (2)H.PREPARER
Preparer of the Sales Disclosure Form Title
Leah Brown Settlement A ent
Email Address Telephone Number
Company
closings@regionaltitlelic.com ( 812 ) 759-5555
Regional Title Services LLC
Address (number and street, city, state, country, and ZIP Code)
7820 Eagle Crest Blvd, Suite 201, Evansville, IN 47715
I. SELLERS)/GRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as appears o u
Jessica M. Campbell
Address (number and street)
Address (number and street) JU�
704 E John Street
City, State, and ZIP Code
City, State, and ZIP Code
Fort Branch, IN 47648
LA
Country
us
Country
GIBSON Chi
Email Address
Telephone Number
Email Address
&ANumber
jessicacampbeiII026@gmail.com
I ( 812 ) 664-4157
( )
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.
S ature of Seller Signature of Seller
y�I
nnted Name of Seller Date Signed (mm/dd/yyyy) Printed Name of Seller Date Signed (mm/ddlyyyy)
Jessica M. Campbell 06/15/2026 06/15/2026
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
Trida Martin
Address (number and street)
Address (number and street) C
695 W 650 S
F City, State, and ZIP Code
City, State, and ZIP Code
Fort Branch, IN 47648
Country
Country
us
Email Address Telephone Number
Email Address Telephone Number
tricia.r.martin5@gmail.com J ( 812 ) 664-3636
( )
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
® O 3. Homestead
® ❑ residence?
❑ ® 4. Solar Energy Heating or Cooling System
O ® 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
❑ ® for this residence? If yes, provide address:
❑ ® fi. Hydroelectric Power Device
O ® 7. GeothermalEnergy Heating or Cooling Device
Address (number and street)
L,
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, SSWDriver's License)/D/Other Number is necessary only if a Homestead Deduction is being Rfed.J
Signature of Buyer 1
of Buyer 2/Spouse
rigSignature
_i wl_ cVQ ,zinn date fMM/DD/YY1
Printed Legal Name of buyer 1 0!911 Lm Lu kiv11V11VVl 1 1 �L_.,'t
.._Tricia Martin 6/15/2026 06/15/2026Last 5 Digils of Buyer 1 SSN/Driver's License/1010ther Number 5 Digits of Buyer 21Spouse SSN/Dnver's LicensellDlUther Number II
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