Homestead_Bolen LH. PREPARER
Preparer of the Sales Disclosure Form Title
Stacey Salzman Settlement Agent
Company
Address(number and street,city,state,country,and ZIP Code)
2301 N.Burkhardt Road, Evansville, IN 47715 I
I.SELLERS)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as a ppears4 document
Brad Marchand E
Address(number and street) Address(number and street)
I
707 Radio Ave. - NOd -4 ,4i)
9
City,State,and ZIP Code City,State,and Z P Code /
• Evansville,IN 47725 �O I
US
untry Country /eSn
Email Address ^' Q,e-Q Telephone Number
•
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$-1:1-5.5.A person who knowingly and intentionally falsifies the value of transferred
real.property,or omits or falsifies any' rmation required to be provided,commits a Level 5 felony.
KSOinatur f Selle Signature of Seller
Pn tea Name of Seller Date Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mmldd/yyyy)
j Brad Marchand 11/08/2023 11/08/2023
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 conveyance document
Tyler Bolen Cassidy Rose Bolen
Address(number and street) Address(number and street) i
507 S.5th St. 507 S.5th St.
•
City,State,and ZIP Code City,State,and ZIP Code
Holland, IN 47541 Holland, IN 47541
Country Country
US US •
apply for certain deductions.Identify all of those-thatapply:
YES NO CONDITION YES NO CONDITION
IN O 1.Will this property be the buyer's primary ® O 3. Homestead
residence? 0 3 4.Solar Energy Heating or Cooling System
O ® 2. Does the buyer have a homestead to be vacated 0 al 5.Wind Power Device
for this residence?If yes,provide address: 0 3 6. Hydroelectric Power Device
Address(number and street) O ® 7. Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County
-b - 1UI3
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
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