HomeMy WebLinkAboutHomestead_MazurierH. PREPARER
Preparer of the Sales Disclosure Form
Title
Matthew Jarvis
Escrow Officer
Company
E-mail address
Telephone number
Southwestern Indiana Land Title
matt@swiniand.com
(812) 425-0055
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
Heather Amanda Mazurier
Address (number and street)
Address (number and street)
1133 S 250 W
City, State and ZIP Code
City, State and ZIP Code j
Princeton, IN 47670
Country
Country
United States of America
Email Address
Telephone Number
Email Address
Telephone Number
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.
Signature of Sell r\ n R
I�
Signature of Seller
Printed Name of Seller
1ae Signed (mm/dd/
Printed Name of Seller Date Signed (mm/dd/yyyy)
Heather Amanda Mazurier
YYYY)
6/23/2026
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 co e o u en
Joshua Taylor Mazurier
Address (number and street)
Address (number and street) J Ury 30
1133 S 250 W
ZQ26
City, State and ZIP Code
City, State and ZIP Code
Princeton, IN 47670
Country
Country COUN�l'gDDI
United States of America
Email Address
LTelephone Number
Email Address
Telephone 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:
YES NO CONDITION
YES NO CONDITION
0 ❑ 1. Will this property be the buyer's primary residence?
0 ❑ 3. Homestead
❑ 0 4. Solar Energy Heating or Cooling System
❑ 0 2. Does the buyer have a homestead to be vacated for
this residence? If yes, provide address:
❑ 0 5. Wind Power Device
❑ 0 6. Hydroelectric Power Device
Address (number and street)
❑ 0 7. Geothermal Energy Heating or Cooling
Device
a _ 11 _ i LJ _ 3Oo T dQ \ .' Z 7 —
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T-7
City, State, and ZIP Code 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 spouses information, SSN/Driver's
License/ID/Other Number is necessary if a Homestead Deduction is being fled.)
Si nat re f B er 1
1
Signature of Buyer 2/Spouse
Pri eg of u r 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Joshua Taylor Mazurier 6/23/2026
USNLa�igitsof Buyer 1 SSN/Driver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License%ID/Other Number
ilgo Q 6
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