Homestead_Long H. PREPARER
Preparer of the Sales Disclosure Form Title
Christina Gourley Title Clerk
Company
Address(number and street,city,state,country,and ZIP Code)
4600 Washington Ave, Suite 102, Evansville, IN 47714
I. SELLER(S)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Mission Real Estate Group Inc
Addre L
C:
(number and street) Address(number and street) V LED
D
tc�c,x S43 1
City,state,and ZIP Code City,state,and ZIP Code
C-)<<.:- - s:.'it[Y - N -ti, S-
APR 1 4 9022
Country Country /J
(,CC a¢je ii,7Ky
E-mail address
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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 falsifi any information required to be provided,commits a Level 5 felony.
Signatures slier /� �f' Signature of Seller
Pri Name of SeEJef/ Date signed( m/ddryyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
James M. Chappell O Of/..?c?ms.7, i
J. BUYER(S)/GRANTEE(S)-APPLICATION FORPROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as it appears on conveyance document
Davon Caine Long ,
Address(number and street) Address(number and street)
`°5 E.-Rive S-(-
CJjy,state,and ZIP Code City,state,and ZIP Code
-)rlrkce Eon, '=tM!, '(rl(e7O
Country Country
E-mail address
apply for certain deductions.Identify all of those that apply:
ES NO CONDITION YESNO CONDITION
1. Will this property be the buyer's primary 0 3. Homestead
residence? 0 p 4. Solar Energy Heating or Cooling System
"2 Does the buyer have a homestead to be vacated 0 D 5.Wind Power Device
O /` for this residence?If yes, provide address: p C) 6.Hydroelectric Power Device
Address(number and street) 0 CI 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
aferk2-07-20( -002-. . (Sq -02$ .
3 of 5 & " f