HomeMy WebLinkAboutHomestead_JornsH. PREPARER
Preparer of the Sales Disclosure Form
Title
Kelly E Norton
Settlement Agent
Company
+ Email Address
Telephone Number
Bosse Title Company
I
( 812 ) 421-4000
Address (number and street, city, state, country, and ZIP Code)
4799 Rosebud Lane, Newburgh, IN 47630
I. SELLERS)IGRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seiler 2 — Name as appears on conveyance document
Darrell L. Parker
Debra S. Parker
Address (number and street)
Address (number and street)
302 S. Center St.
302 S. Center St.
City, State, and ZIP Code
City, State, and ZIP Code
Fort Branch, IN 47648
Fort Branch, IN 47648
Country
Country
I us
us
Email Address I Telephone Number Email Address Telephone Number
dparker215@twc.com ( 812 ) 664-7519 (��a )(QGq-751c
Under penalties of pedury, 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 f leny.
Signature of Seller
- 1/7
5i at re f Ile r=_
k- -=-�
Printed Name of Seller
Date Signed (mm/d yyyy)—
Printed Name of Seller —
"Dat Signed (mm/dd/yyyy)
Darrell L. Parker
07/31/2026
Debra S. Parker
07/31/2021
J. BUYER(S)IGRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS — IDENTIFY APPLY
Buyer 1 — Name as it appears on conveyance document
Buyer 2 —Name as it appears on conviaLf o me
Karen Jorns
Address nu� el and et) 11
Address (number and street) — —
Ir I/
City, Sta ` and Z P Cod
! City, State, and ZIP Code 6
Country
us
Country
GIB
Email Address
Telephone Number
Email Address
r
karenmichellel023@yahoo.com
( 618 ) 944-1630
( )
Pursuant to IC 6-1.1-11-04, the Sales Disclosure Form may be used to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION YES /NO CONDITION
O 3.
(� O 1. Will this property be the buyer's primary CiY Homestead
residence? O ® 4. Solar Energy Heating or Cooling System
O n —. Does the buyer have a homestead to be vacated O ® S. Wind Power Device
for this residence? If yes, provide address:_ O ® 6. Hydroelectric Power Device
_
Address (number and street) p ® 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County
ia- oar
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 j
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 LicensellD/Other Number is necessary only if a Homestead Deduction is being riled.)
Signat�re of Buyer 1
Signature of Buyer 2/Spouse
Printed Lega Name cat Buyer 1 Sign Date (MMIDD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Karen Jorns � 7/31/2026
07/31/2026
Last 5 Digits pf Buyeyl SN/Drivef's
License/ID/Other N tuber
__
Last 5 Digits of Buyer 2/Spouse SSN/Driver sLicense/ID/Other Number
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