HomeMy WebLinkAboutHomestead_PerryH. 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)/GRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as it appears on conveyance document
Thomas Mason
Georgiana Mason
Address (number and street)
Address (number and street)
9397 E 125 S
9397 E 125 S
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
Telephone Number
Email Address 17eiephone
Number
Rz -le 6 q LIS- I I
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 6A.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.
ignature of Se inn
Si ture of Seller
�n Y Y (�-,
5�
Printed Name of Seller
Date Signed (mm/dd/
Printed N e of Seller Date Signed (mm/dd/yyy
Thomas Mason
yyyy)
I
Georgiana Mason 9/16/2026
9/16/2026
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
Katelynn Perry
Address (number and street)
Address (number and street) jrl_LJ�D
City, State and ZIP Code
_7UL,0
City, State and ZIP Code SEP
,IN �,
,
Country
Country
United States of America
Email Address Telephone Number
Email Address GIBSON
n � umber
75) a q o ac�� j
COURT
!1lJDIT
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
❑ 0 6. Hydroelectric Power Device
Address (number and street)
❑ 0 7. Geothermal Energy Heating
or Cooling Device
CCU
-
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
LicenseliD/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)
Katelynn Perry 9/16/2026
Last 5 Digits of Buyer 1 SSN/Driver's License/ID/OttAr.Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's
LicenseflD/Other Numb,
01
SSN: Q cS5-5q / L_
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