HomeMy WebLinkAboutHomestead_Bradshaw (5) H. PREPARER
Preparer of the Sales Disclosure Form Title
Angela J. Moers Escrow Officer
Company
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)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as it appears on conveyance document
Brian K. Sullivan Paula J. Sullivan
Address(number and street) Address(number and street)
3602 N 175 W 3602 N 175 W
City, State and ZIP Code City, State and ZIP Code
Patoka, IN 47666 Patoka, IN 47666
Country Country
United States of America United States of America
Email 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.
Sign 1S.eller---- Signatuta,of Seller ,
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Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date sign d(mm/dd/ yyy)
Brian K. Sullivan `j o -"L/ Paula J. Sullivan C z617Ozq
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
Rylee Bradshaw
Address(number and street) Address(number and street) PIL-eb
SOS (\ �1,KO.tk�
City, State and ZIP Code (\ 1 —� t City, State and ZIP Code
H its-\ G\ --3 Sic" ,
Country U� ���� Country MdR 22
United States of America 2°14.4.4e, 202¢
Email Address
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Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions. Identify all of those th4Ty:
Y_E,S`_/NO CONDITION Yir NO CONDITION
• 1. Will this property be the buyer's primary residence? 3. Homestead
0 EJ 4. Solar Energy Heating or Cooll>tig System
2. Does the buyer have a homestead to be vac test for jhi�, -:1:.:
()A residence? If yes, provide address: �O� f�' 0 5. Wind Power Device ��M . &" 'j ,.,
- A ' 0 El 6. Hydroelectric Power Device ;' '
Add ass tuber anFistreet) �U`-tip 0 El 7. Geothermal Energy Heating or Cooling Device �'
2- S Kn�r✓1 es - 2`' �O
City, 76xcnde,and county
-Dn - y+66G .26 -0L/-,Dy- 3.,Q- Dom . As- o.a
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct and complete
5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
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�n 1- m St.Q1� 203 s ( ,ins L _ eA i s ., . . .
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