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Homestead_Cullivan (3) , ti H. PREPARER Preparer of the Sales Disclosure Form Title Daphne Kramer Paralegal Company Address(number and street,city,state,country,and ZIP Code) 226 W Broadway St., Princeton, IN 47670 I. SELLERS)/GRANTOR(S) Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on convey ce cu ant Teresa M.Cullivan Address(number and street) Address(number and street) ,A y� 4668 N 775 E 0k City,state,and ZIP Code City,state,and ZIP Code l0 Francisco, IN 47649 eat)i USAwz Coun try Country "'Se 4/On Q E-mail address 4 Under penalties of perjury,I hdreby certify this Sales Disclosure,to the beat of my knowledge and belief,is true,corkItand complete as required by law,and is prepared in accordance with IC 6-1.15,5.A parson 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. Xigna ^ Seller /� ' v�.�l- n Signature of Seller Printed Name of Se er _ Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy) Teresa M. Cullivan ,',_ 8 - z o Z. 4 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 Brandon M.Cullivan Address(number and street) Address(number and street) 6066 E 390 N City,state,and ZIP Code City,state,and ZIP Code Francisco, IN 47649 USA Country Country E-mail address ( ) Pursuant to IC 6.1.1.12444,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply: YES NO CONDITION YES NO CONDITION O O 1.Will this property be the buyer's primary O 0 3.Homestead residence? 0 O 4.Solar Energy Heating or Cooling System O O 2.Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device for this residence?If yes,provide address: 0 O 8.Hydroelectric Power Device Address(number end street) 0 O 7.Geothermal Energy Heating or Cooling Device City,state,ZIP code,and county 2C o la-Zoo -©00. 4-ik8-09- . Under penalties of perjury,I hereby certify that this Sales Disclosure,to the beat of my knowledge and belief,Is true,correct and complete of 5 "A