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Homestead_Ash H. PREPARER Preparer of the Sales Disclosure Form Title Lana Harper Escrow Officer _ Company Address(number and street,city,state,country,and ZIP Code) 5231 Oak Grove Road,Suite A,Evansville,IN 47715 I. SELLER(S)1GRANTOR(S) Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document Christopher E.McCulley Lois E. McCulley r(`/,umber and„street) j( '<, Address(numbeind are City,,ktete,and ZIP Code -- , _.. /� ' `... '� -� City,state,and ZIP�Cod Country Country United States of America United States of America __.,...._ E-mail address Ta p ne 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. Si r of Se ig p'tu of Seller Printed Name of Se ler Date sig ed( imld lyy./y) Printed Name of Seller I Date/sjgn d(m dd/ ) Christopher E.McCulley ''ttli d1 Lois E.McCulley 1 1O 7 tr J. BUYER(S)/GRANTEE(S)-APPLICATION F R I ROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY Buyer 1-Name as it appears on conveyance document Buyer 2-Name as appears on conveyance document Matthew Ash Stephanie Ash Address(number and street) Address(number and street) 4025 S.State Rd.65 _ 4025 S.State Rd.65 City,state,and ZIP Code City,state,and ZIP Code Owensville,IN 47665 Owensville,IN 47665 Country Country United States of America United States of America for certain deductions.Identify all of those that apply:W YES NO CONDITION YES NO CONDITION t» ; 00 ❑ 3.Homestead co p hrj ❑ 1.Will this property be the buyer's primary residence? ❑ B 4. Solar Energy Heating or Cooling Sys o H 2.Does the buyer have a homestead to be vacated for 0 RI 5.Wind Power Device t.J N ❑ En this residence? If yes, provide address: ___._.,.,__ 0 B 6. Hydroelectric Power Device c j a Address(number and street) i ❑ © 7.Geothermal Energy Heating or Cocain ice ci City,state,and ZIP Code County 1 26-10 36-200 003.932-021 co