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Homestead_Caniff
H. PREPARER Preparer of the Sales Disclosure Form Title Matthew Jarvis Escrow Officer Company Address(number and street, city, state, country, and ZIP code) 605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713 I. SELLER(S)/GRANTOR(S) Seller 1 -Name as it appears on conveyance document Seller 2-Name as it appears on conveyance document Century Home Builders, LLC,an Indiana limited liability company Address(number and street) Address(number and street) 9408 S. US Hwy 41 City,State and ZIP Code City, State and ZIP Code Haubstadt, IN 47639 ' Country Country United States of America 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. _pna o r Signature of Seller Printed Name of Seller Date signed (mm/dd/yyyy) Printed Name of Seller Date signed (mm/dd/yyyy) Phil Reinbrecht, President 2/23/2022 2/23/2022 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 app vey �DL^�[nent Taylor Caniff _ /J-.+Jj■ Address�(number and street) Address(number and street) LI Ov I 6 00 w City, State and ZIP Code MAR 0 42U22 City,State and ZIP Code ©W E/VSV`.ZLLLGj S/1/ y 76 65- Country `�7z�,,4.;, Country GIBSOR? ti. `° " United States of America E-mail address to apply for certain deductions.Identify all of those that apply: YES NO CONDITION YE i- NO CONDITION QV ❑ 1. Will this property be the buyer's primary residence? ,� 0 3. Homestead 0 El 4. Solar Energy Heating or Cooling System 0 ciK. Does the buyer have a homestead to be vacated for 0 El 5. Wind Power Device this residence? If yes, provide address: 0 El 6. Hydroelectric Power Device Address(number and street) 0 El 7. Geothermal Energy Heating or Cooling Device City, State,ZIP code,and county 2-//-5/-35d UO cW..1•.S L7a 2-/ 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 Information,SSN/Drivers License/ID/Other Number is necessary if a Homestead Deduction is being filed.) C 0 PY