Homestead_Boxdorfer H. PREPARER
Preparer of the Sales Disclosure Form TitleEscrow Officer
Matthew Jarvis Telephone number
Southwestern Indiana Land Title
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
SPM Development, Inc.,an Indiana corporation doing business as
Reinbrecht Homes
Address(number and street) Address (number and street)
City, State and ZIP Code
Country
304 E SR 68
City, State and ZIP Code
Haubstadt, IN 47639
Country
United States of America Telephone number
my ingly an de intentionally falsifiesnd belief, is true, rrect and complete as
the value of transferred
required by
real property,or omits or falsi any information required to be provided,commits a Level 5 felony.
'. -I of Seller Signature of Seller
Pri-• • •-me of Seller Date signed(mm/dd/yyyy) Printed Name of Seller
I Date signed(mm/dd/yyyy)
Brooke Traylor,Authorized Signer 11/17/2022
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
as it appears on conve e document
dyer 1 -Name - it appears on conveyance document 11 Danielle R. Boxdorfer ILE40
Brian M. B . •er street)
•.. -__ er and street)
104 E. Gassman St. 104 E. Gassman St. N
City, State and ZIP Code City, State and ZIP Code OV 3
Olney, IL 62450 Olney, IL 62450 7022
Country
United States of America G/BSONz p ti.�fy
E-mail es of America
ONDI I �
NO C
YES NO CONDITION Homestead
Q ❑ 1. Will this property be the buyer's primary residence? 4 Q 0
'a 4. Solar •- •• eating or Cooling System _I
❑ Q 2. Does the buyer have a homestead to be vacated for ❑ p 5. Wind Power Device c
this residence? If yes, provide address: 0 p 6. Hydroelectric Power Device
Address(number and street) 0 RI 7. Geothermal Energy Heating or Cooling Device
ij/_
City, State,ZIP code,and county /ag -0 - p�-.a . 7/0•772?
and
elief,is true,correct and
as Under
law,perjury, I hereby
is prepared in accordanertify that ce with IC is Sales Disclosure,
1 1 55rA person who knowingly land intentionally falsifies the value of complete
transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
.