Homestead_Riley (2) H. PREPARER
Preparer of the Sales Disclosure Form Title
Abbigail Moers 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 on conveyance document
Tyler C. Cushman
Address(number and street) Address(number and street)
1012 S. Center St.
City,State and ZIP Code City,State and ZIP Code
Fort Branch, IN 47648
Country Country
United States of America
E-mail address
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.
',nature of Seller Signature of Seller
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-Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Tyler C. Cushman 1/18/2022 1/18/2022
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
Hunter Michael Riley Kaleigh Hooker
Address(number and street) Address(number and street)
395 E. 200 S. 395 E. 200 S.
City,State and ZIP Code City, State and ZIP Code
Princeton, IN 47670 Princeton, IN 47670
Country Country
United States of America United States of America
E-mail address
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:
11•1E?I' NO CONDITION YES NO CONDITION
El ,,,1. Will this property be the buyer's primary residence? O 3. Homestead :1)
0 21 4. Solar Energy Heating or Cooling ST.t4
0 Ild 2. Does the buyer have a homestead to be vacated for this 0 El 5. Wind Power Device
residence? If yes, provide address: ›-
0 WI 6. Hydroelectric Power Device 1-1 t I—
Ad d re s s(number and street) 0 21 7. Geothermal Energy Heating or Co1aiii4vice
= 0
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City,State,ZIP code, and county
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complet)‹.Ej
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.(Note:Both spouse's
information, SSN/Driver's License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
. .
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