Homestead_Madison (3) H. 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. SELLERS)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Joretta Hart
Address(number and street) Address(number and street)
308 S.Stout St.
City,State,and ZIP Code City,State,and ZIP Code '
Princeton, IN 47670 `4:1
Country Country
US '.4,
Email Address 444) Telepho : AP ,
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowiedt3}r4,: •• .•lief,is true, and complete as
required by law,and is prepared in accordance with IC 6-1 1-5.5.A person who knovngly an• 0i:0:+,-Ily falsifies th value of transferred
. real property,or omits or falsifies any information required to be provided,commits a Level 5 feio
lure of Seller S nature of Seller { '
PP te�of Seller -ey- 1 3\)
Da e i ned �J
t Sg (mmlddlyyyy) Printed Name of Seller 03: igned(rnm/dd/yyyy)
Joretta Hart 02/27/2024 02/27/2024
J. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALLTHAT APPLY
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as it appears on conveyance document
Darrien A.Madison
Address(number and street) Address(number and street)
635 N.Busch Ct.
City,State,and ZIP Code City,State,and ZIP Code
Princeton,IN 47670
Country Country
NO CONDITION
1.Will this property be the buyer's primary ® 0 3. Homestead
® O residence?
0 IN 4.Solar Energy Heating or Cooling System
® 2.Does the buyer have a homestead to be vacated 0 (N 5.Wind Power Device
for this residence?If yes,provide address: 0 ® 6. Hydroelectric Power Device
1 Address(number and street) 0 ® 7. Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County b!1 -* -11(1 2-0 0) VQ ( --r'? c(
b
Under-penalties of perjury;!hereby certify that thie.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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