Homestead_Balen H. PREPARER 1
Preparer of the Sales Disclosure Form Title
Timothy Shea . Settlement Agent
Company E-wait address ,
'
Address(number and street city state country and?IP Code?
20 NW 1st Street,Suite 100, Evansville,IN 47708
I. SELLER(S)/GRANTOR(S)
Se:klq 1 Name as it appears oil conveyance document Seler 2. Name as appears on conveyance document
Steven E.Fuller,Jr. . Melissa L.Fuller
Address(number and street) Address(number and street)
5R8-E-64ata-Strer6f 0'0 .4/;,e/e1 ,Aft.k- -L,28 t otate-b-Treat ---)6,7-? i" .Y4.,/-c.,,-e.
City stale and ZIP Code City state and ZIP Code
Prineetee-rIN'47670 ---i--/;44"/3-Z".;>//0 "^" 5177i 2--- Princeton,IN 47670
Country Country
. Us . US ---
required by law,and-. pared in accord?' - — -son who knowingly and intentionally falsifies the value of transferred
real pr• •n, y,or o • •r falsifies any Info, led,commits a Level 5 felony_
S•gn. ,,,of Selin / / Signature of Seller
Printed Nar5Mftbler I Date signed(rornicid yyyy) Printed Name of Seller Date signed(rnm•dd'yyyy)
Steven . uller,Jr. 06/21/2022 Melissa L.Fuller .1,1/2022
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY AL P Y
Buyer 1 Name as it appears on conveyance document Buyer 2 Name as it appears on conveyance dópn
Joseph Balen ,./0/ .,4)
-
Address(number and street) Address(number and street)„ - 0 S',
113013-SW-5th-6tfeel.,--Apactrwee4-7.f2,01 9-S' E- 57-111-e 51 ' Ws. elleo
‘90 .-
C•
City stale and ZIP Coue, City state and ZIP Code Co
Yulsee,-QX.-7-2•999 V 04(--e A 0(1 , (/i (-ti 0-7 0
Country Country
Ok
US
E-mad 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 agl 0 3. Homestead
ail 0 residence? 0 IR 4.Solar Energy Heating or Cooling System
,.--, 2.Does the buyer have a homestead to be vacated CD Ck 5.Wind Power Device
0 L_I for this residence?If yes,provide address 0 12 6.Hydroelectric Power Device
•
Address(number and street) 0 (X 7.Geothermal Energy Heating or Coaling Device
City.slate LIP code,and county
1 cN%-12 -07-7,04- oo o. 0 go -02z
. ..
5
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