Homestead_Rembe H. PREPARER
Preparer of the Sales Disclosure Form Title
Amanda Daly Settlement Agent _ __
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 on conveyance document
I
ra
Larry W.Bailey L .._.; D
Address(number and street) Address(number and strut T
2173S50E I
City,slate,and ZIP Code City,state,and ZIP Code MAY 8.1 2 2
Princeton,IN 47670
Country Country /y//�� , l/
us C yY�iDIT R
GIBSON COU
( )
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 Level 5 felony.
Si na�turrer�off Seller (3 Signature of Seller
Prin Name f Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mmfddlyyyy)
Larry W.Bailey 05/20/2022 05/20/2022
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
Larry G.Rembe Lorri K.Rembe
Address(number and street) Address(number and street)
9745 Grand Teton,Unit 1070 9745 Grand Teton.Unit 1070
City,stale,and ZIP Code City.slate,and ZIP Code
Las Vegas,NV 89166 Las Vegas,NV 89166
Country - Country
US US
_ _.,-_
YES NO CONDITION I-YES NO CONDITION -�--
1_Will this property be the buyer's primary IXi 0 3. Homestead
® 0 residence? 0 l 4. Solar Energy Heating or Cooling System
—0 2.Does the buyer have a homestead to be vacated 0 a 5.Wind Power Device
for this residence?If yes,provide address: 0 a 6. Hydroelectric Power Device
Address(number and street) 0 CV 7.Geothermal Energy Heating or Cooling Device
City,state.ZIP code,and county
fib- L-n- 1OO-OOt . 133 -02'+ -
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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