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Homestead_Shipley H. PREPARER Preparer of the Sales Disclosure Form Title Christa D.Tracey 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 2—Name as it appearsFI on co�LeYa�,�ent Seller 1 —Name as it appears on conveyance document L SPM Development, Inc., an Indiana corporation doing business as Reinbrecht Homes Address(number and street) Address(number and street) MAR 21 2022 304 E S R 68 City, State and ZIP Code City, State and ZIP Code �. .1 a 1,-,-:----a Haubstadt, IN 47639 COUP►T' ,.,, Country Country GIBSON United States of America E-mail address Under penalties of perjury,I hereby ce 'fy`this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete as required by law,and is prepared i cordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the value of transferred real property,or omits or fal . s any information required to be provided,commits a Level 5 felony. gn t of Seller Signature of Seller Date si ned (mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy) E3,6 Erin ame of Seller g 3/9/2022 oke Traylor, �c ,4� 3/9/2022 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 Dina J. Shipley Leonard A. Shipley Address(number and street) Address (number and street) Q 108 E. Mill St. 108 E. Mill St. C 0 PY cJ City,State and ZIP Code City, State and ZIP Code C Patoka, IN 47666 Patoka, IN 47666 1 Country Country United States of America United States of America apply for certain deductions. Identify all of those that apply: © YES„ NO CONDITION YES NO CONDITION i q/� ❑ ). Homestead Q 0 1. Will this property be the buyer's primary residence? ❑ 4. Solar Energy Heating or Cooling System �❑ 2. Does the buyer have a homestead to be vacated for ❑ . Wind Power Device 1 this residence? If yes, provide address: ❑ �, Hydroelectric Power Device 1/1 Address(number and street) _-3 ❑ ❑/7. Geothermal Energy Heating or Cooling Device N \ S lNI F. M k\ "T Ico nt '` ^.1 c City, ate.,ZIP1C� code, and t ��f7kt..�y %.-\)— I c-' o Z- oo-\ - `T' 1 -oZ- _ t Under penalties'Jooff perjury,I-hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete N 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/Driver's License/ID/Other Number is necessary if a Homestead Deduction is being filed.)