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Homestead_Elmore H. PREPARER Preparer of the Sales Disclosure Form Title Micah Scott Escrow Officer Company NAddress(number and street, city,state, country,and ZIP Code) 7412 Eagle Crest Blvd. Evansville, IN 47715 CS I. SELLER(S)/GRANTOR(S) © Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conveyance document Cory J. Fougnies Ly Address(number and street) Address(number and street) 4vi sg F 5-r RA E 6, 6 City,state,and ZIP Code City,state,and ZIP Code ` t'-n-z mil ..,.,. ` -AV- 4 c 1 Country Country ( ) Cr-- Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete as sie 8 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 t real props or omits or falsifies any information required to be provided,commits a Level 5 felony. dS" Si natur f eller Signature of Seller 2 P t ame i S er " Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy) VO ory J. Fougnies 01/25/2022 O J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-ID NT L THAT APPLY C) T Buyer 1 —Name as it appears on conveyance document Buyer 2—Name as it appears on c eyan ocument en M Austin Oak Elmore t� <- JNO ,Ca) W Address(number a d streek Address(nu d street) ' City,state, d ZIP Code City,state,and ZIP S -,<^ 3 T N Country C A Country T e IP 0 4.1E- ( ) C 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: "f --a YES NO CONDITION YES NO CONDITION 4- O 0 1.Will this property be the buyer's primary O 0 3. Homestead residence? 0 O 4. Solar Energy Heating or Cooling System 7F 2. Does the buyer have a homestead to be vacated 0 C) 5.Wind Power Device O for this residence? If yes, provide address: O Q 6. Hydroelectric Power Device Address(number and street) 0 C) 7. Geothermal Energy Heating or Cooling Device g City,state,ZIP code, and county �� - �^ 39O - OoI _0'A -earl •CPUnder ,/ 'b 22 Page 3 of 5 \ clovi,cgiw,,tA kS IS 4 P i4/✓Gei c- o4-Zr-400-ogo.Li --1 t Page 3 of 5 1..�N„._ ) aric . 11'1 is 0.0J L is 'c7c. )� s) 1Gag� 0vl of 8 1,e, t,,.0 bo Avi led. -$oti... 13 AddAtcv)r`�'��