HomeMy WebLinkAboutHomestead_GuernseyH. PREPARER
Preparer of the Sales Disclosure Form
Title
Matthew Jarvis
Escrow Officer
Company
E-mail address
Telephone number
Southwestern Indiana Land Title
matt@swiniand.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. SELLERS)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as it appears on conveyance document
Jared Payne
Address (number and street)
Address (number and stre
517 N Hart St
City, State and ZIP Code
City, State and ZIP Code
Princeton, IN 47670
Country
Country U62026
United States of America
Email Address I-Telephone
mb�'�
Email Address G/QSON
Telephone Number
IS
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Under penalties of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge and belief, is true, c P&ai 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 trai ferred real property, or
omits or falsifies any information required to be provided, commits a Level 5 felony.
Signature of Seller
r
Signature of Seller
PrInted Name of Seller
te Signed (mm/dd/
Printed Name of Seller Date Signed (mm/dd/yyyy)
Jared Payne
y)
T814/2026
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
Matthew Guernsey
Address (number and street)
Address (number and street)
10656 Main St.
City, State and ZIP Code
City, State and ZIP Code
Cynthiana, IN 47612
Country
Country
United States of America
Email Address
Telephone Number
Email Address
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
YES NO CONDITION
0 ❑ 1. Will this property be the buyer's primary residence?
0 ❑ 3. 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:
❑ 0 5. Wind Power Device
❑ C 6. Hydroelectric Power Device
Address (number and street)
❑ Cd 7. Geothermal Energy Heating or Cooling Device
( \ L�-�7 �00'_ coo,
( 0 - U I
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 filed.)
ignature of Buyer 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)
Matthew Guernsey 8/4/2026
Last 5 Digits of Bier 1 SSN/Driver' License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
SSN: 5 160 y ^1 d W ?JA
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