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Homestead_Earnst
H. PREPARER Preparer of the Sales Disclosure Form Title Shannon Valiant 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 Jamie L. Payne FKA Jamie L Earnst Address (number and street) Address (number and street) coo W goo S Pc53ot Ci City, State and ZIP Code City, State and ZIP Code p F -i (6 �Uo 10 H 7(O -I Country V Country " E-mail address 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. ' nature of a er Signature of Seller inted Name of Set er Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy) Jamie L. Payne FKA Jamie L Earnst -3t?7i202-3 i(,{ d0.3 ` J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY .4 ,, Buyer 1 -Name as it appears on conveyance document Buyer 2-Name as it appears on conveyance docietat Christopher D. Earnst Address (number and street) Address(number and street) �44 , ,r 6292 W. Old Princeton Rd. �i'j • �¢ ,� City, State and ZIP Code City, State and ZIP Code BS04, �0�� Owensville, IN 47665 �'OGQ Country Country i/ii United States of America '9Gbb4- E-mail address apply for certain deductions. Identify all of those that apply: YES NO CONDITION YES NO CONDITION El 0 1. Will this property be the buyer's primary residence? © 0 3. Homestead 0 © 4. Solar Energy Heating or Cooling System 0 2 2. Does the buyer have a homestead to be vacated for 0 2 5. Wind Power Device this residence? If yes, provide address: 0 ICJ 6. Hydroelectric Power Device Address(number and street) 0 IZI 7. Geothermal Energy Heating or Cooling Device City,State,ZIP code, and county — 6- UP —100 CZ°. ORa- as(