Homestead_Bainbridge III H. PREPARER
Preparer of the Sales Disclosure Form Title
Amanda Daly -_Settlement Agent _T —
Company
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 Seller 2-Name as appears TIT.:i�in nip
Household Thoughts,LLC
JjHH�J
Address(number and street) Address(number and street)
9559 E Main Street MAY 1 3 2U22
City,state.and ZIP Code City.state,and ZIP Code (, �.c
Mackey,IN 47654 y�e79 ✓^4+'
Country Country GtB SON O Y AUDITOR
US
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 of Seller Signature of Seller
/-N -- �� ` Date signed(mmldd!
Printed Name of Seller I Date signed(mmfddlyyyy) Printed Name of Seiler 9 yyyy)
Brian S.Ellis, L 05/09/2022 05/09/2022
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
Richard Bainbridge,III
Address(number and street) Address(number and street)
96 W 800 S Apt 1202
City,state.and ZIP Code City.state,and ZIP Code
Fort Branch,IN 47648
Country Country
US
apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary (J 3. Homestead
residence'? 0 (2 4.Solar Energy Heating or Cooling System
'tli\
�..,/2. Does the buyer have a homestead to be vacated ! 0 CR 5.Wind Power Device
O for this residence'?If yes,provide address! p Q 6.Hydroelectric Power Device
Address(number and street) 0 (X 7.Geothermal Energy Heating or Cooling Device
City.state-ZIP code.and county L-- - —iq_3o i -coo . °2 t -00 Z
F e% -s
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