Homestead_Doerner H. PREPARER
Preparer of the Sales Disclosure Form
Title
Allyn Tresenriter Escrow Officer
Company : :
Address(number and street,city,state,country,and ZIP Code)
7412 Eagle Crest Blvd Evansville, IN 47715
I.SELLER(S)/GRANTOR(S)
Seller 1-Name as it:appears,on conveyance document Seller 2-Name as appears on convey d nt
Amy C. Sullivan
Address(number and reef
Address(number and street) k-i)
834 ol/ Or
City,slate,a d ZIP de: /s City;state,and ZIP Code Dee Country
ee42LCZv- C! -Er 7(oGci° ,2 �,?�?!!
Country 7
US US : %
N A alUnder penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,is true,correctl�6l,f�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
r-al property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
S'•nature of eller
Signature of Seller.
Jj G' t� J
f ed Name of Seiler/J' Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Amy C. Sullivan 12/11/2024
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
Jalen Doerner
Address(number and street) Address(number and street) 1' ysr r
2808 South 650 East ,• 411,City,state,and ZIP Code City,state,and ZIP Code =z # ,i
Francisco IN 47649 {. `
Country Country. ,
US US
number ..
( )
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions:Identify all of those that apply:
O YES NO CONDITION YES NO CONDITION
0O O 1.Will this property be the buyer's primary : 00 : 3. Homestead
residence? 0 O 4.Solar Energy Heating or Cooling System
f rF _ .
J 2. Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device
for this residence? If yes,provide address: O O 6. Hydroelectric Power Device
c". Address(number d street) 0 (0 7.Geothermal Energy Heating or Cooling Device
11�- 'i`,kite,. S
t City state,ZIP code,and county
r 0 Alf '" an -(9-64s Zb-13-2a—lot,-obi :G3��-004
+T 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
( transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
'"-Q information,SSN/Driver's License/ID/Other Number is necessary if a Homestead Deduction is being filed.)EN
Last 5 of SSN: .
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