Homestead_Scott (5) •
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
SPM Development, Inc.,an Indiana corporation doing business as
Reinbrecht Homes
Address(number and street) Address (number and street)
304 E SR 68
City, State and ZIP Code City, State and ZIP Code
Haubstadt, IN 47639
Country Country
United States of America
E-mail address
Under penalties of perjury,I he y certify this Sales Disclosure,to the best of my knowledge and belief, is true,correct and complete as
required ,and is pre ed in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the value of transferred
real pe , omits or Isifies any information required to be provided,commits a Level 5 felony.
• nat of S ler Signature of Seller
rinted N Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Brooke Traylor,Authorized Signer 3/18/2022 3/18/2022
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 v ce d m
111)
Donna J. Scott
Address(number and street) Address (number and street) MAR 2 8 2022
1800 Meadow Lane
City, State and ZIP Code City, State and ZIP Code
Lincoln, CA 95648 a1 a. �t .,
Country Country GIBSON COUNTY 7;1:umber
United States of America
E-mail address
apply for certain deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
0 El 1. Will this property be the buyer's primary residence? 0 ❑ 3. Homestead
0 0 4. Solar Energy Heating or Cooling System
0 0 2. Does the buyer have a homestead to be vacated for ❑ 0 5. Wind Power Device
this residence? If yes, provide address: 0 0 6. Hydroelectric Power Device
Address(number and street) 0 0 7. Geothermal Energy Heating or Cooling Device
City,State,ZIP code, and county
AC-Ii- I -1n3 -00ci . 42Y- - 02g
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
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Othr Number