HomeMy WebLinkAboutHomestead_Rose (2);^Ofeparer of the Sales Disclosure Form
Matthew Jarvis
Title
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
Terry G. Liles
Linda C. Liles
Address (number and street)
Address (number and street)
610 S Ninth Ave
610 S Ninth Ave
City, State and ZIP Code
City, State and ZIP Code
Haubstadt, IN 47639
Haubstadt, IN 47639
Country
Country
United States of America
United States of America
Email Address
Telephone Number
Email Address Telephone Number
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unaer 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.
ignature of Seller
--- Signat re of Seller
Printed Nameof Seller Date Signed (mm/dd/ Printed Name of Seller Date Signed (mm/dd/yyyy
Terry G. Liles yyyy) Linda C. Liles 9/15/2026
9/15/2026 `L L `)
J. BUYER(S)/GRANTEE(S) —APPLICATION FOR PROPERTY TAX DEDUCTIONS —IDENTIFY ALL THAT APP
Buyer 1 — Name as it appears on conveyance document Buyer 2 — Name as it appears on con c t
James A. Rose, by Jana M. Mercer, his attorney -in -fact Sylvia A. Rose
Address (number and street) Address (number and street)
6458 S 175 E 6458 S 175 E
City, State and ZIP Code City, State and ZIP
Fort Branch, IN 47648 Fort Branch, IN 47648 ONC Q
Country Country �-
United States of America United States of America
Email Address Telephone Number Email Address Telephone Number
Jimrsyl@gmail.com: (812) 753-3835 Jimrsyl@gmail.com (812) 753-3835
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
0 ❑ 1. Will this property be the buyer's primary residence?
IZ ❑ 2. Does the buyer have a homestead to be vacated for
this residence? If yes, provide address:
Address (number and street)
6458 S 175 E
City, State, and ZIP Code
Fort Branch, IN 47648
YES NO CONDITION
2 ❑ 3. Homestead
❑ L1 4. Solar Energy Heating or Cooling System
❑ 0 5. Wind Power Device
❑ 0 6. Hydroelectric Power Device
❑ [Z 7. Geothermal Energy Heating or Cooling Device
- ate- t01-0 - aCyn - 00C) .'R as
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/lD/Other Number is necessary if a Homestead Deduction is being filed.)
County
Gibson
nature of Buyer 1 Signature of Buyer 2/Spouse
P ' ted Legal Name o Buyer 1 Sign Date (MM/DD/YY) Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
James A. Rose, by Jana M. Mercer, his 9/1512026 Sylvia A. Rose 9/15/2026
attorney -in -fact
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: � �'79� IN PC 84670 SN: ry—pv 7-A/- /5L._ 4/7C*9A