Homestead_Sullivan H. PREPARER
Preparer of the Sales Disclosure Form Title
Escrow Officer
Matthew Jarvis
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
Teresa Market
Address(number and street) Address (number and street)
1910 S. Boulevard PI.
City, State and ZIP Code City, State and ZIP Code
Princeton, IN 47670 '
Country Country
United States of America
E-mail address address Telephone number
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.
Sig ure of Seller , �
Signature of Seller
_64
�" "‘G(" Printed Name of Seller I Date signed(mm/dd/yyyy)
Pn a Name of Seller Date signed (mm/dd/yyyy)
Teresa Market 5/20/2022
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIF L/T T APPLY
Buyer 1 -Name as it appears on conveyance document Buyer 2-Name as it appea conn document
Michael C. Sullivan �. _� /L,
Address (number and street) Address (numb and str 2
705 W. Broadway St 7Z0,2
City, State and ZIP Code City, State an ,��,,
Princeton, IN 47670 COu'N ,��
Country Country A0-g,5O
United States of America Telephone number
E-mail address 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:
YES NO CONDITION YES .-''NO CONDITION
❑ 1. Will this property be the buyer's primary residence? ❑ 3. Homestead
�� CIO 4. Solar Energy Heating or Cooling System
0 R.l" 2. Does the buyer have a homestead to be vacated for ❑ p 5. Wind Power Device
this residence? If yes, provide address: ❑ p 6. Hydroelectric Power Device
Address(number and street) El RI 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county
4:71-/2 -\ -\ -70v1- aOD - (70-3-tea
3