Homestead_Fortner H. PREPARER
Preparer of the Sales Disclosure Form Title
Matthew Jarvis 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
John Heldt Rita Heldt
Address(number and street) Address(number and street)
621 S Country Lane 621 S Country Lane
City,State and ZIP Code City, State and ZIP Code
Princeton, IN 47670 Princeton, IN 47670
Country Country
United States of America United States of America
Email Address Email Address
omits or falsifies any information required to be provided,commits a Level 5 felony.
ignatk of�ell� igna C gf. r „
Printe• Name of Seller Date Signed(mm/dd/ Printed Name of Seller Date Signed(mm/dd/yyyy)
John Heldt YYYY) Rita Heldt 5/2/2025
5/2/2025
J. BUYER(S)IGRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT APP
Buyer 1 —Name as it appears on conveyance document Buyer 2—Name as it appears on ey o ent
Laura Fortner �J
Address (number and street) Address(number and street)'7AY D
610 Kieffer Ave ? Ani,
City, State and ZIP Code City, State and ZIP
Mt. Carmel, IL 62863 O/eS0
CO f,Z
Country Country N �OU
United States of America rygVOi
certai deductions.Identify all of those that apply:
YE, NO CONDITION Y NO CONDITION
�/ El . Will this property be the buyer's primary residence? ❑ 3. Homestead
El 'i 2. Does the buyer have a homestead to be vacated for 0 El 4. Solar Energy Heating or Cooling System
this residence? If yes, provide address: 0 RI 5. Wind Power Device
Address (number and street) 0 El 6. Hydroelectric Power Device
❑ El 7. Geothermal Energy Heating or Cooling Device
City,State, and ZIP Code County 26- G j./D -Roo
Rop - /. 0�-- .I g
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(i
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