Homestead_Bradshaw H. PREPARER
Preparer of the Sales Disclosure Form Title
Haley Smith Escrow Officer
Company
Address(number and s'- - :ity.state.country.and ZIP Code)
7412 Eagle Crest Blvd Evansville, IN 47715
I. SELLERS)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as ap eal onve n nnent
Jason A.Bradshaw
Add um r and street) Address(number and t'
1V7 K 5• 6.0 0 122
14ci*st t�ar�d yl o J_17 ✓ � LI7 6 � City,state, n ZIP Code 2?4 /�
Country ly Country 67 SON Q '/
US US O(7 Zr.
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.
gn ture f, ller J Signature of Seller
Pri ed Nam of Seller D gp �m/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Jason A. Bradshaw p 1��tf
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
•
— ame as i a n conveyance document Buyer 2—Name as it appears on conveyance document
Alescia M. Bradshaw
Address(number and street) Address(number and street)
904 Virgil Boulevard
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670
Country Country
YES
O O 1.Will this property be the buyer's primary O 0 3. Homestead
residence? 0 Q 4.Solar Energy Heating or Cooling System
O 12.Does the buyer have a homestead to be vacated 0 (25.Wind Power Device
for this residence? If yes,provide address: O O 6. Hydroelectric Power Device
Address(number and street) O (2 7.Geothermal Energy Heating or Cooling Device
City state.ZIP code.and county
626 -/,Z -/8 . poi - aoA . 8 a s- ' -
C
G\DIA\A S:1LES DISCLOSURE FOR��I SDF ID 26-2009-1000598 A Pate?