Homestead_Adams (11) H. PREPARER
' Preparer of the Sales Disclosure Form ' Title
Haley Smith Escrow Officer
Company E-mail address Telephone number
Foreman Watson Land Title hsmith@FW-LT.com (812 ) 909-4543
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 conveyance document
Nina Jean Holderbaugh Sharon Elaine Williams
Address number and street) Address(number and treet) _
City tale,and ZIP Code City,state,and ZIP Code
- -l n GRAD a, '\.) VIA-6 •-A-0 -,---\-- 03 c-and. , i --iN u O-G 41
Country Country
US US
E-mail address .kw L, Telephone number E-mail address ®)j►r''-O^+1 Telephone number
t nlA e\ \ OA 6) CO (812) 664-3823 rj S\N:1 yvE_Lk.al.( C (812) 457-9759
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.
i a re f Sififrit...743,2 Sig ture of Seller V
P' led Nameller D signed(mmldd/yyyy) r e Name of a er Date signed(mm/dd/yyyy)
Ina Jeanerbaugh 2 /2025 Sharon Elaine Williams 2/3/2025
J. BUYER(S)IGRANTEE(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
Sheila Adams BLE
Address(number and street) Address(number and street
1620 West Tulip Blossom Lane
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670 FEB 05 `
Co ntry Country ( 2025 i� ,
US
E-mail address Telephone number E-mail address �� _"`�C /Telephone number
adams-Sheila@outlook.com (812) 664-9502 G4BSONCQ �e t
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Ident?rall 15fAt :1- apply:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary O 0 3. Homestead
O O residence? 0 D 4.Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated O O 5.Wind Power Device
O for this residence?If yes,provide address: O O 6. Hydroelectric Power Device
Address(number and street) 0 1 1 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
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
information,SSN/Driver's License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
Si nature of Buyer 1 j Signature of Buyer 2/Spouse Q-)\
Printed Legal Name of Buyer 1 Sign Date(MM/DD/YY) Printed Legal Name of Buyer 2/Spouse Sign Date(MM/DD/YY)
Sheila Adams 2/3/2025
Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
Last 5 of SSN:12291 Last 5 of SSN:
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