Homestead_Sellers H. PREPARER
J - ------
Preparer of the Sales Disclosure Form Title
Kandace Rogers Closing Agent
Company
Address(number and street,city,state,country, and ZIP Code)
4905 Theater Drive, Evansville, IN 47715 ��
I. SELLERS)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conve �
Michael F.Tenbarge ,t
ds
re s(nr(ilrbrter n street f (� Address(number and street) �441 ir
_ I �`\\JJ�� ii 11 .-!! U1 i., , ?�23
Cl %�d Z, �t ` /��� /� City,state,and ZIP e
•
U fn it lL /kJ Y 7/ Country Ca/eSON CO
Country " '•(A Ift
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.
Sig at a of S ler Signature of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Michael F.Tenbarge January 12, 2023 January 12, 2023
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
Rachel M. Sellers akis•aa(slikbilet " Isaac Sellers
Address(number and street) Address(number and street)
416 South West StreetHaubstadt, IN 47639 416 South West Street
City,state,and ZIP Code City,state,and ZIP Code
Haubstadt, IN 47639 Haubstadt, IN 47639
Country Country
USA USA
1.Will this property be the buyer's primary ❑X El 3.Homestead
0 ❑ residence? ❑ X❑ 4.Solar Energy Heating or Cooling System
❑ D/ 2.Does the buyer have a homestead to be vacated El 5.Wind Power Device
Lei for this residence?If yes,provide address: ❑ 0 6.Hydroelectric Power Device
Address(number and street) 0 X❑ 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
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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