HomeMy WebLinkAboutHomestead_BunnageH. 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
4G Services LLC, an Indiana Limited Liability Company
Address (number and street)
Address (number and street)
364 S 325 W
City, State and ZIP Code
City, State and ZIP Code
Princeton, IN 47670
Country
Country
United States of America
Email Address
Tel hone Number
Email Address
Telephone Number
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- .1-5.5. person who knowingly and intentionally falsifies the value of transferred real property, or
omits or falsifies ny information required to prov' d, co mits a Level 5 felony.
Signature r
Signature of Seller
W
Printed,Wame of Selle
a Signed (mm/dd/
Printed Name of Seller Date Signed (mm/dd/yyyy)
Kerry Goforth, Merroer
yyyy)
9/29/2026
J. BUYER(S)/GRANTEE(S) —APPLICATION FOR PROPERTY TAX DEDUCTIONS —IDENTIFY ALL THAT APPLY
Buyer 1 — Name as it appears on conveyance document
i Buyer 2 — Name as it appears oilconveyance document
Adam Henry Bunnage
Address (number and street)
Address (number and street)
2958 County Road 1330
City, State and ZIP Code
City, State and ZIP Code OCT
Ellery, IL 62833
0 1 2026
Country
Country
United States of America
Email Address IlTelephone
Number
Email Address GIBSON COU
Number
Nn'
UDITOR
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 ONDITION
YES NO CONDITION
❑ ❑ 1. Will this property be the buyer's primary residence?
0 ❑ 3. Homestead
❑ R1 4. Solar Energy Heating or Cooling System
❑ 2. Does the buyer have a homestead to be vacated for
this residence? If yes, provide address:
❑ 9 5. Wind Power Device
❑ 0 6. Hydroelectric Power Device
Address (number and street)
❑ 0 7. Geothermal Energy Heating or Cooling Device
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.)
SignatVre 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)
Adam Henry Bunnage 9/29/2026
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: S Y/y3 XL Q L! 50071
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