HomeMy WebLinkAboutHomestead_GrayH. PREPARER
Preparer of the Sales Disclosure Form
Title
Matthew Jarvis
Escrow Officer
Company
E-mail address
Telephone number
Southwestern Indiana Land Title
matt@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
I. SELLER(S)IGRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as it appears on conveyance document
Devon W. Bailey
Chelsey D. Bailey
Address (number and street)
Address (number and street)
219 W Washington St.
219 W Washington St.
City, State and ZIP Code
City, State and ZIP Code
Oakland City, IN 47660
Oakland City, IN 47660
Country
Country
United States of America
United States of America
Email Address
elephone Number
Email Address
elephone Number
672 ;; 'V11, 5
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.
Cigna re of Seller
ig aturee of Seller
Printed Name of Seller
Date Signed (mm/dd/
Printed Name oft,$eller Date Signed (mm/dd/yyyy)
'V
Devon W. Bailey
yyyy)
Chelsey D. Bailey 8/25/2026
8/25/2026
r
J. BUYER(S)1GRANTEE(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 documen f
Jared T Gray
Address (number and street)
Address (number and street)
219 N. Prince St.
City, State and ZIP Code
City, State and ZIP Code G/B s
SON
Princeton, IN 47670
COON Ize
Country
Country lop
United States of America
Email Address
Telephone Number
Email Address
Telephone Number
warextechnical@gmail.com
(812) 430-5059
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 ❑ 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:
❑ R1 5. Wind Power Device
❑ 0 6. Hydroelectric Power Device
Address (number and street)
❑ 0 7. Geothermal Energy Heating or Cooling Device
_ 1G�_lg_ �Oa �, �51 — CO
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 spouses information, SSN/Drivers
LicenseAD/Other Number is necessary if a Homestead Deduction is being filed.)
ign r uyer 1
Signature of Buyer 2/Spouse
rin ed Legal Name of Buyer 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Jared T Gray 8/25/2026
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 DL r
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