Homestead_Jordan H. PREPARER °
Preparer of the Sales Disclosure Form Title
Leah Brown Settlement Agent
Company
Address(number and street,city,state,country,and ZIP Code)
7820 Eagle Crest Blvd,Suite 201, Evansville,IN 47715 _
rI. SELLER(S)/GRANTOR S
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Jana J.Warren,Trustee of the Jana J.Warren Revocable Trust Dated Qt051v119u'?Aim
-f
Address(number and street) Address(number and street)
1708 W Brumfield Ave ,
City,State,and ZIP Code City,State,and ZIP Code
Princeton,IN 47670
( Country Country
} US
best of my knowledge and belief,Is true,correct,and complete as
Pr7ry.
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
ea property,or omits or falsifies any Information required to be provided,commits a Level 5 felony.
Sig ture of Set Signature of Seller
s VI°(� 2&-
nn ed Name eller Dale Si nut(.4-1d ) Printed Name of Seller Date Signed(mm/dd/yyyy)
Jana J.Warren,Trustee & _
J. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTI LL THAT APPLY
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as it appears on yT document
Thomas Jordan
Address(number and street) Address(number and street) •' '‘* ,,.tc'A
4505 ,/U
.City,StateSate,,and ZIP Code City,State,and ZIP e ,> <..iiii .(i )._..)
C
Evansville,IN 47710 C/ ' Or '
Country Country SO4,- eps
US \
q'; ( )
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identil ose that apply:_
-YES NO CONDITION YES NO CONDITION
® ❑ 1.Will this property be the buyer's primary () 0 3.Homestead
residence? 0 CZ 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated 0 ® 5.Wind Power Device
❑ ® for this residence? If yes,provide address: ❑ ® 6.Hydroelectric Power Device
Address(number and street) 0 ® 7.Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County ZQ
Page 3
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