Homestead_Cultice H. PREPARER
Preparer of the Sales Disclosure Form Title
Jamie E. Oberg Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
101 Plaza East Boulevard, Suite 102, Evansville, IN 47715
I. SELLER(S)/GRANTOR(S) rnn dd c 1
Seller 1 —Name as It appears on conveyance document Seller 2—Name as appears on i7Mel t
THE ESTATE OF MARTHA B. HART 1
Address(number and street) Address(number and street) OCT 3 1 2022 Ift
City,state,and ZIP Code City,state,and ZIP Code
ti-h,...4,7,.1 a. VV '
Country Country GIBSON COUNTY AUOi r u,
E-mail address
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,cgommits a Level 5 felony.
Ignature of Seller ' l�� _ Siggi t e ofXer
Printed Name of Seller Date signed(mm/dd/yyyy) Pr' ted Name of Seller Date signed(mm/dd/yyyy)
TFRFSA A.MANS. On-Fxeciaor October 24, 2022 3 y- w . MY'-l" October 24, 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
BRIANNA M.CULTICE KATELYN MARIE VAN KEIRSBULCK
Address(number and street) Address(number and street)
717 McCarty Road 717 McCarty Road
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670-2858 Princeton, IN 47670-2858
Country Country
E-mail address
certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary C12� 0 3. Homestead
00 residence? ❑ 0 4.Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated 0 [ 5.Wind Power Device
❑ for this residence? If yes, provide address: ❑ ®' 6.Hydroelectric Power Device
Address(number and street) D ® 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
- ( I -- I -Li o 0 -000 1 i2 - (D2
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete
.
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