Homestead_Wenzel H. PREPARER
Preparer of the Sales Disclosure Form Title
Abbigail Moers 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 •-,. • \-yance document
SPM Development, Inc., an Indiana corporation doing business as °
Reinbrecht Homes
-.1(0
Address(number and street) Address(number st e
304 E SR 68, Haubstadt, IN 47639 rr 0t
City, State and ZIP Code City, State and ZI ode .k
Haubstadt, IN 47639 <�
Country. Country . y V,
United States of America G v��
E-mail address E-mail address 504 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 fats''es any information required to be provided,commits a Level 5 felony.
InAie./.- - �/ 5; Signature of Seller
Prin ed Name • -tier " Dateigned (mm/dd/yyyy). Printed Name of Seller Date signed (mm/ddlyyyy)
Adam Gann,Authorized Signer 2/22/2021 2/22/2021
E-mail address \
,., 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
,1 ❑ 1. Will this property be the buyer's primary residence? 0 El 3. Homestead
D El 0 4. Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated for El 0 5. Wind Power Device
t this residence? If yes, provide address:
j El 0 6. Hydroelectric Power Device
T A dress(numbe and street)
i (1,��� 0 0 7. Geothermal Energy Heating or Cooling Device
i City,State,and ZIP Coe Cou y
0 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
t property,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's information,SSN/Driver's
License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
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