Homestead_Thompson (10) H. PREPARER
Preparer of the Sales Disclosure Form Title
Kandace Rogers Closing Agent
Company
Address(number and street,city,state,country,and ZIP Code)
4905 Theater Drive, 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
Ryan K. Nielsen Jamie T. Nielsen
Address(number and street) Address(number and street)
$I -C 3 LA_.)-e i- C 1 0 $ I' -n t.1..)-e a-‘ S
.state.and ZIP Code Cii state,and ZIP Code
CtJ� P t e sTsp � ) LI(n'3II : try Q i e S[' N__)
Country Country
USA USA
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Signature of Seller • nature of Sell
,�--�'� ->7�'.- ( (
Print of Seller Date signed(mm/dd/yyyy) i Tinted Name of Seller Date signed(mm/dd/yyyy)
Ryan K. Nielsen 9/30/2022 J ie T. Nielsen 9/30/2022
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
William F. Thompson FILE
Address(number and street) Address(number and street)
421 South Spring Street
•-•._)3..-N,
City,state,and ZIP Code City,state,and ZIP Code OCT 1 3 2022
Princeton, IN 47670
Country Country e�
USA /f"Lic-44.G1 a. t in°)
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 I. ❑ 3. Homestead
❑ residence? ❑ 14 4.Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated El _ix 5.Wind Power Device
❑ for this residence? If yes,provide address: ❑ 6. Hydroelectric Power Device
Address(number and street) ❑ 7. Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county o. 6 6 3�ll���-ono— o o -02
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
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