Homestead_Fullerton H. PREPARER
Preparer of the Sales Disclosure Form Title
Haley Smith Escrow Officer
Company
Address (number and street, city, state, country, and ZIP Code)
7412 Eagle Crest Blvd Evansville, IN 4771512 °'''
I. SELLER(S)IGRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conie e docurn t
Shawn C. Fullerton ij,
Address (numb and treet)ec ar flue, . Address (number an.
I m _ 's o - 42)
tip,
City, state, and ZIP ode I City, state, and ZIP Code p Q
�OcV .}i I. 1 a qfl V — vtiii..•
CoUs
and intentionally falsifies the value of transferred
real property, or omits or falsifi s an information required to be provided, commits a Level 5 felony.
�-o eller Signature of Seller
Printed Name of Seller Date sig ed ( m/dd/yyyy) Printed Name of Seller Date signed (mm/dd/yyyy)
Shawn C. Fullerton a 1 ( f g.0, 3
J. BUYER(S)IGRANTEE(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
Charles V. Fullerton
Address (number and street) Address (number and street)
2467 East 600 South
City, state, and ZIP Code City, state, and ZIP Code
Fort Branch, IN 47648
Country Country
US US
those that apply:
YES NO CONDITION ' ES NO CONDITION
1. Will this property be the buyer's primary f C) 3. Homestead
El 0 residence? I f 4. Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated O f 5. Wind Power Device
---> ° J for this residence? If yes, provide address: O f 6. Hydroelectric Power Device
Address (number and street) O O 7. Geothermal Energy Heating or Cooling Device
City, state, ZIP code, and county
a(?— /I_ aq- yan - col. 6 --as
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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