Homestead_Coomer (29) H. PREPARER
Preparer of the Sales Disclosure Form Title ,,
A
Pb ^ _ t4 Title Company _—, -
Company 1
Address(number and street,city.state,country,and ZIP Code)
7820 Eagle Crest Blvd,Suite 201,Evansville, IN 47715
I. SELLERS)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document 4 Seller 2-Name as appears o c n y ce u le
Edward B.Prior Il
Address(number and street) Address(number and street) MAR 2 9 2022
1701 Martin Lane _
City,state.and ZIP Code City.state.and ZIP Code
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Princeton,IN 47670 Y A
Country ! Country GIBBON L vuNTY AUDITOR
US
E-mail address
etephone number rE-mail address Telephone number
) ( )
Under penalties of perjury,I hereby certify 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 Levet 5 felony.
(::: Signature offf Seller Signature of Seller
Printed Nam�oi Seiler Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/ddlyyyy)
Edward B.Prior lziy_ohtaPr;octi . 03/21/2022 03/21/2022
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
Ryan Coomer Amy J.Kelley
Address(number and street) Address(number and street)
6136 W Stalhem Avenue 6136 W Stalhem Avenue
City,state,and ZIP Code City,state,and ZIP Code
Owensville,IN 47665 Owensville,IN 47665
Country Country
US US
5
( )
L� Pursuant to IC 6-1.1-12-44,the Sates Disclosure Form may be used to apply for certain deductions.Identify all of those that apply:
Mom( YES NO CONDITION YES NO CONDITION
\� 1.Will this property be the buyer's primary CV 3. Homestead
S rX1 residence? 0 fL 4.Solar Energy Heating or Cooling System
Co
0 �Q 2.Does the buyer have a homestead to be vacated 5.Wind Power Device
t (/�_ for this residence?If yes,provide address: 0 IR 6.Hydroelectric Power Device
O Address(numb r and street) 0 ($' 7.Geothermal Energy Heating or Cooling Device
M kig f S ip W. S1-a f h e(t N e-Kkue.
City.state.ZIP code,and county
t b sVilitt. \c urI(o( -CA-2o3-r Z gt2G _0 p
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete
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