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Homestead_Summerville H. PREPARER __ Preparer of the Sales Disclosure Form Title Kandace Rogers Closing Agent ____. Company Address(number and street,city,state,country,and ZIP Code) 4905 Theater Drive, Evansville, IN 47715 I. SELLER(S)/GRANTOR(S) Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document Celestia M. Church — Address(number and street) Address(number and street) tNjty,state,and c IP Coc.e City,state,and ZIP Code Y C l. 0 S) .L — Country ountry USA ( ) 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 at Seller Signature of Seller f 4 J I t I r �,ed Na e ofSell t ti/t.Li Lh=/ 5! t(t l I G f��/ Gat _ Printed Name of Seller Date signed(mmldd/yyyy) Printed Name of Seller l Date signed(mm/ d/yyyy) Celestia M. Church 01/10/2022 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 conveyance document Ryne Summerville Address(number and street) Address(number and street) 504 West Mulberry Street City,state,and ZIP Code City,state,and ZIP Code Princeton, IN 47670 -Country Country CONDITION m O ❑ 1.Will this property be the buyer's primary p 0 3.Homestead p c residence? 0 O 4.Solar Energy Heating or Cooling Sys til - 1-4 O 2.Does the buyer have a homestead to be vacated 0 [.] 5.Wind Power Device z -'NI It'll for this residence? If yes,provide address: ❑ CI 6.Hydroelectric Power Device tli y Qs N a Address(number and street) 0 © 7.Geothermal Energy Heating or Coolies 'ce 0 City.state,ZIP code,and county 26-12-07 303-000.965-028 rn 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 spouse's