Homestead_Sullenger H. PREPARER
Preparer of the Sales Disclosure Form Title
Jamie E.Smith Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
101 Plaza East Boulevard, Suite 102, Evansville, IN 47715
I.SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on nve n doc ent
Harold W.Johnson
Address(number and street) Address(number and street)
3268E 1025 South 46, .41)
City,State,and ZIP Code City,State,and ZIP ode 2/Haubstadt, IN 47639-8037 2,02s
Country Country G'/eS
Off,CQ CO
E-mail Address
best of my knowledge and belief,is true, ect 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 f IIfies any information required to be provided,commits a Level 5 felony.
Sign to of Se)ler I Signature of Seller
t-f-� Les . ��--
Printed Name of Seller 6' Date Signed(mm/dd/yyyy)— Printed Name of Seller Date Signed(mm/dd/yyyy)
Harold W Johnson January 17,2025 _ January 17,2025
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
Jodi L.Sullenger Duane Sullenger
Address(number and street) Address(number and street)
3268 E 1025 South 3268 E 1025 South
City,State,and ZIP Code City,State,and ZIP Code
Haubstadt, IN 47639-8037 Haubstadt, IN 47639-8037
Country Country
apply for certain deductions.Identify all of those that apply:
YES NO CONDITION . YES -NO CONDITION
l
❑ 1.Will this property be the buyer's primary ET 3.Homestead
residence? 0 E" 4.Solar Energy Heating or Cooling System
Does the buyer have a homestead to be vacated 0 [I' 5.Wind Power Device
El E for this residence?If yes,provide address: ❑ Er 6.Hydroelectric Power Device
Address(number and street) ❑ EJ 7.Geothermal Energy Heating or Cooling Device
City,State,ZIP code,and County 2`_\C -3/-1-- ,0 Q _000 /'2,o _02
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
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