Homestead_Kelly H. PREPARER
Preparer of the Sales Disclosure Form Title
Escrow Officer
Comp D.Tracey
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)/GRANTER(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as it appears on conveyance document
Jeanie Lea Followell
Address(number and street) Address(number and street)
721 S. Prince St.
City, State and ZIP Code City, State and ZIP Code
Princeton, IN 47670
Country
Country
United States of America Telephone number
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,commits a Level 5 felony.
Signature of Seller n� �'dr.) ��--��////��^(�/l-//ol � Signature of Seller
JrLU • CAI Date (mm/dd/yyyy) Printed Name of Seller I Date signed(mm/dd/yyyy)
PrintedNameofS I I `Z_Z(�-Z-L
Jeanie Lea Folio I
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 cony ance document
KatedsM Kelly ��
Address(number and street) Address(number and street) "'���CCC j�
700 E.Walnut St. O'-C. r
City, State and ZIP Code City, State and ZIP Code L'3
O
Fort Branch, IN 47648 Country 0/@- e
Country N
;44 %
United States of America
OO4/,:fr ephone number
E-mail address
used to apply for certain deductions. Identify all of those that apply:
YES/'NO CONDITION YEES/ NO CONDITION
❑ 1. Will this property be the buyer's primary residence? I! 0 3- Homestead
0 I�,"�4. Solar Energy Heating or Cooling System
0 Does the buyer have a homestead to be vacated for ❑ W o, Wind Power Device
this residence? If yes, provide address: 0 Hydroelectric Power Device
Address(number and street) ❑ t:zGeothermal Energy Heating or Cooling Device
City,State,ZIP code,and county 26_ -O7_30,/ _ cxpl , 611 -ba.g
Under penalties of perjury,I hereby certify that 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.(Note:Both spouse's
CP ,,,