Homestead_Gregory H. PREPARER
Preparer of the Sales Disclosure Form Title
Shannon Valiant c C_2-C>va 1:::+ t c'zz-,-
Company
Southwestern Indiana Land Title
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
Celia P. Donnelly
Address(number and street) Address(number and street)
1330 Darwin Avenue
City,State and ZIP Code City, State and ZIP Code
Princeton, IN 47670 '
Country
Country
United States of America Telephone number
E-mail address
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.
Signa re of Seller Signature of Seller
/
'0'4 "-n p-, Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Celia P.Name ll Seller 12/13/2021 112/13/2021
Celia Donnelly
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
Danielle L.Gregory
Address(number and street) Address(number and street)
536 W. Emerson St
City, State and ZIP Code City, State and ZIP Code
Princeton, IN 47670 '
Country
ountry
United States of America Telephone number
E-mail address
to apply for certain deductions. Identify all of those that apply: 4
YES NO CONDITION cc
C
YES NO CONDITION 4`I=
❑ 1. Will this property be the buyers primary residence? IK ❑ 3. Homestead _ q o
❑ 4. Solar Energy Heating or Cooling$' teen cv
0 2. Does the buyer have a homestead to be vacated for ❑ 5. Wind Power Device jj,,�� }.
this residence? If yes, provide address: ❑ 6. Hydroelectric Power Device ` (-
Address(number and street) 0 7. Geothermal Energy Heating or C Devii o
� I W . U
County in
City,State,and ZIP Code 26-/Z_07 g04/-cpi-7 .02-9' m_
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct affd'-
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