Homestead_Taylor (2) H. PREPARER
Preparer of the Sales Disclosure Form Title
Cody L Pruett Closing Agent
Company
Address(number and street,city,state, country,and ZIP Code)
4600 Washington Ave., Suite 102, Evansville, IN 47714
I. SELLERS)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Brianna M. Cultice Katelyn Van Keirsbulck
Address(number a street) Address((nnumber and street)
n f j. 3e Y� i n r i--r-) c'� . CJ 9- 4 Ci - Y t+lv O iA Lc1-
City, at d ZIP
slat Code �( City,state,and ZIP Code
Country
Country
E-mail a ess Telephone number E-mail addres �
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�eller Signature of Seller —
�� �,�/_ W
Pnnted Name of Seller I Date signed(mm/d ,.-
diyyyy) r 1N Ted l me of Sellef Date igned(mm/dd/yyyy)
8nanna M. Cultice �'/ 2�� '3 Katelyn Van Keirsbulck ��V, 1,5
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
Oaklee Taylor Sarah Jane Taylor
Address(number and street) Address(number and street)
'-i 's Eask g"„' S Lt 05 SC,'A' fr.d St
rCity,slate,and ZIP Code City,state,and ZIP Code
14 e -z e.1 t o:. Y N t-t"t is I4 c'-z.z I !-O r. I ti 1-i l i_, (7
Country
Country
E-mail address
YES NO CONDITION YES NO CONDITION
❑ 1.Will this proper the 's primary V 0 3. Homestead
residence?
.�'[� 0 O 4.Solar Energy Heating or Cooling System
❑ 2. Does the', iiAr A ve a hom to be vacated ❑ O 5.Wind Power Device
fo is residence leye rovide address:
� � D D 6. Hydroelectric Power Device
Address(num* et 3 •
�SC� ) ❑ O 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,an ,^ . ..j
Under penalties of perjury,I hereby ciitl hat this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete
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