Homestead_Schurman H. PREPARER
Preparer of the Sales Disclosure Form Title
Lynette Murray First Advantage Title Services
Company
Address(number and street,city,state,country,and ZIP Code)
2301 N.Burkhardt Road,Evansville,IN,USA 47715
I.SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Terry Queen Tammy Queen
Address(number and street) Address(number and street)
(C)u( pi • 1 hOr►-) !tie
City,state,and ZIP Code / City,st ar Q'ode
Country Country
E-mail address
( )
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 6-1.1-5.5.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.
x9ign re of Seller na 41 f Seller
Printed Nam of Seller_
elleer Date signed(mm/dd/yyyy) P nted Nameer .����� Date signed(mm/dd/yyyy)
Terry Queen c? 1 )-')1 Tammy Queen l 3-c?
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
Jordan C.Schurman Chelsey E C Schurman
Address(number and street) Address(number and street)
LP t'l Le ? GJ S taI kl CM Is
City,state,and ZIP Code City,state,aid'lP/,fo '
�` f p) 41 .'5 J0% `�
�/(AtU1�v I �
Country Country
E-mail address
apply for certain deductions.Identify all of those that apply: 6-)
YES NO CONDITION YES NO CONDITION E
,,/ a 1.Will this property be the buyer's primary 0 3.Homestead zCD tii
ll�� residence? Q 0 4.Solar Energy Heating or Cooling System 8 cr_
H
z
� 0 0 5.Wind Power Deviice 2.Does the buyer have a homestead to be vacated ;)aIv
for this residence?If yes,provide address: 0 V 6.Hydroelectric Power Device y IV tli
Address(number and street) p V 7.Geothermal Energy Heating or Cooling Deaic 0
I ci clol 1--__ (,2, e n f ec C(- 0
Ci ,state,and ZIP Code Coun
ty, L � r ty 26-11-31-300-004.320-021 33
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