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Homestead_Fraize H. PREPARER Preparer of the Sates Disclosure Form Title Amanda Daly Settlement Agent Company Address(number and street,city,state,country,and ZIP Code) 7820 Eagle Crest Blvd,Suite 201,Evansville,IN 47715 I. SELLER(S)(GI4h1NTOR(S) • Seller 1-Name as It appears on conveyance document Seller 2—Name as appears on conveyance document Tamara Wallace Address(number and street) Address(number and street) 1652 Pond Gannett Lane City,state,and ZIP Code City,state,and ZIP Code Jacksonville,FL 32259 Country Country US ( ) 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 6-1.1-5.6.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 o alter , / Signature of Seiler Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mmfddlyyyy) Tamara Wallace 12/03/2021 12/03/2021 J. BUYER(S)IGRANTEE(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 conveyance document Charlene Fraize Address(number and street) Address(number and street) 556E200N ' City,state,and ZIP Code City,state,and ZIP Code Princeton.IN , Country ountry US NO CONDITION G) m 1.Will this property be the buyer's primary 1 1 3.Homestead C. 0 residence? p ( 4.Solar Energy Heating or Cooling Sy4 o o i 2.Does the buyer have a homestead to be vacated 0 l 5.Wind Power Device c —+ r o ® N CZ] for this residence? Il yes,provide address: © tgl 6. Hydroelecl�rC Porver Device o D IV Address(number and street) 0 1 7.Geothermal Energy Heating or Cooll g co tj o - City,state,and ZIP Code County 26-11-14-101-000.542-027 zi c) 3