Homestead_Sursa H. PREPARER
_
Preparer of the Sales Disclosure Form Title
Chris Sullivan Closer
Company
Address(number and street,city,state,country,and ZIP Code)
7820 Eagle Crest Blvd Ste 201,Evansville,IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as It appears on conveyance document Seller 2-Name as appears on conveyance document
Lindsey(Munnier)Rodriguez
Address(number and street) Address(number and street)
701 S Main Street
City,state,and ZIP Code City,state,and ZIP Code
Fort Branch,IN 47648
Country Country
E-mail address
mail address Telephone number
Imunnier@hotmail.com
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 6-1.1-55.5.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.
:;.,fature of Sel er Signature of Seller
Printed Name of e er �igned(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Lindsey(Munnier)Rodriguez 02/12/21 02/12/21
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
Janet L.Sursa
d eas(nu.I•moo r et)ct Address(number and street)
Cit ,`state,and ZIPUC,od'eUU City,state,and ZIP Code
[N Xfl v\\\Q, IN (XIV
Country WJV Country
E-mail address \.1131 ^ E-mail address Telephone number
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 YES NO CONDITION t
,{ O 1.Will this property be the buyer's primary O 3.Homestead z
Y� residence? 0 PM
0 ' 4.Solar Energy Heating or Cooling System 8 - 0- H
O 2.Does the buyer have a homestead to be vacated O 5.Wind Power Device a N
cfd r
for this residence? If yes, provide address: 0 ? 6.Hydroelectric Power Device D N tri
Address(number and street) 0 ,2 7.Geothermal Energy Heating or Cooling DER
-i
-
City,state,and ZIP Code County xi
26-18-24-204-000.899-026 0
co
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