Homestead_Kayser H. PREPARER
Preparer of the Sales Disclosure Form Title
Stacey Salzman Settlement Agent
Company
Address(number and street,city,state,country,and ZIP Code)
2301 N.Burkhardt Road,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
Eagle Limited Liability Company
Address(number end street) Address(number and street)
9653 E 450 S
City,state,and ZIP Code City,stale,and ZIP Code
Oakland City,IN 47660
Country Country
US
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 oml or fa Ifles any Information required to be provided,commits a Level 5 felony.
ign lure of II /- /, Signature of Seller
Printed ame o`f So tersigned(
� Date mmldd/YYYY) Printed Name of Seller Date signed(mmiddiyyyy)
Rick Falls, 01/28/2022 01/28/2022
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
Kellie Kayser • '
res rer endstreet) c, Address(number and street)
C�{, l tt te,and�jIP Code 1\( �y• �) City,state,and ZIP Code
�ounts�. r,,, i 0.- 1(k t) ! j Lj Country . ILED
Country ((]]�19�
US 4 ,) gt 'h'F>f'+5ber
apply for certain deductions.Iden , J..p(6 PAV tTOR
YES NO CONDITION YES NO CONDITION GIBIV 0 BON
1.Will this property be the buyer's primary
CD 3.Homestead
residence? 0 ( 4.Solar Energy Heating or Cooling System
O 179 2.Does the buyer have a homestead to be vacated 0t 5.Wind Power Device
for this residence?If yes,provide address: 0 LA 6.Hydroelectric Power Device
Address(number and street) 0 129 7,Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County C1 ( ,f k_ I tQ ,.,r0 1 ,-6 0 O • o o ( -0 0' , _
Under penalties of perjury.1 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