Homestead_Roosevelt H. PREPARER
Preparer of the Sales Disclosure Form Title
Matthew Jarvis Escrow Officer
Company
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 conveyance document
Tim R. Roosevelt Itit/L)
Address(number and street) Address (number and street)
4767 W 125 S
City, State and ZIP Code City, State and ZIP Code MQY
Princeton, IN 47670 3 w 2n24
Country Country G/B
United States of America SON COv�J�
Email Address Address YgVO�phone Number
Under penalties of perjury, I hereby certify this Sales Disclosure,to the best of my knowledge and belief, is tru 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 fal fie e value of transferred
real property,or arg,or falsifies any information required to be provided, commits a Level 5 felony.
.,/Signature of ! r Signature of Seller
'1, (�1(lk
Printed Nam o Seller Date Signed (mm/dd/ Printed Name of Seller ✓(fN Date Si • •� /dd/yyyy)
Tim R. Roosevelt YYYY) `1a Z
5/20/2024 �2#
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY9j1PPLY
Buyer 1 —Name as it appears on conveyance document Buyer 2— Name as it appears on r "N wOocume
Cynthia A. Roosevelt Address (number and street) 114/0/TO
Address(number and street) R
4767 W 125 S
City, State and ZIP Code City, State and ZIP Code
Princeton, IN 47670
Country Country
United States of America
apply for certain deductions. Identify all ' at apply:
YES NO CONDITION YES NO CONDITION Ak
❑ 1. Will this property be the buyer's primary residence? 0 ❑ 3. Homestead
❑ RI 4. Solar Energy Heating or Cooling System •
❑ El 2. Does the buyer have a homestead to be vacated for ❑ 0 5. Wind Power Device
this residence? If yes, provide address:
❑ El 6. Hydroelectric Power Device
Address(number and street) ❑ p 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County
' LQ - I l -«- HCO 000. .3(--k°i -Qal
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
•
•