Homestead_Moore 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
Century Home Builders, LLC, an Indiana limited liability company
Address (number and street) Address (number and street)
9408 S. US Hwy 41
City, State and ZIP Code City, State and ZIP Code
Haubstadt, IN 47639
Country Country
United States of America
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.
Sign ure of Se I isatufz, Signature of Seller
Printed N e of Seller Date signed (mm/dd/yyyy) Printed Name of Seller I Date signed (mm/dd/yyyy)
Brittney N Pavlichek, Authorized Signer 8/10/2022
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
Alex W. Moore Rebecca K. Moore
Address (number and street) Address (number and street)FILED
2180 SR 68 2180 SR 68
City, State and ZIP Code City, State and ZIP Code
Haubstadt, IN 47639 Haubstadt, IN 47639
Country Country AUG 1 2 ;,, j%2
United States of America United States of America
E-mail address
YES NO CONDITION YES NO CONDITION
E ❑ 1. Will this property be the buyer's primary residence? 1 ❑ 3. Homestead
0 2 4. Solar Energy Heating or Cooling System
0 El 2. Does the buyer have a homestead to be vacated for 0 p 5. Wind Power Device
this residence? If yes, provide address:
❑ RI 6. ydroelectric Power Device
Address(number and street) 0 E 7. Geothermal Energy Heating or Cooling Device
City, State, ZIP code, and county � -/q-(8- .0- co.). 4/7 3 IJa S
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct and complete