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Homestead_Eblen • H. PREPARER Preparer of the Sales Disclosure Form Title Milton Norman AA' Settlement Agent Company �.E-mail address _ - - Address(number and street.ofy,stale,country,and ZIP Code) 25 NW Riverside Drive,Suite 310,Evansville,IN 47708 I I.SELLER(S)JGRANTOR(S) -----_T Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on doc rent MacKenzie R.Burgess Address(number and street) i Address(number and street) �2532 Old State Rd 65 _... _ .). ., --.46-.1 . City.slate.and ZIP Code _ ' City,state,and ZIP Code f N ' Owensville,IN 47665 Country s Country 11p13 us l dies E-mail address beet of my knowledge and belief,I9 and complete as required by law,and is prepared In accordance with IC 6-1.1-5.5.A person who knowingly and Intentionally value of transferred real property,or omits or falsifies any Information required to be provided.commits a Level 5 felony. Signature-of Seiler - Signature of Seller - Pr diTarna of Seller Date signed(mmfddhyyy) Printed Name of Seller Date signed(mmrddlyyyy) ' MacKenzie R.Burgess __.5/v 3 _ J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY Buyer 1-Name as it appears an conveyance document Buyer 2-Name as it appears on conveyance document I Billy R Eblen Diana Eblen Address(Dumber and street)-. Address(number end scree c ti ..G1(-.. .t. . .. . . _ 61-1 rj c .,state,and ZtP Code City.state,and zIP Code y • r Country Country US US ' YES NO CONDITION . YES NO CONDTION 4 © 1.Will this property be the buyer's primary AV 0 3.Homestead residence? 0 () 4.Solar Energy Heating or Cooling System © 2.Does the buyer have a homestead to be vacated 0 RI 5.Wind Power Device for this residence?If yes,provide address: 0 M 6.Hydroelectric Power Device Address rum r a street) -1 • © ( 7.Geothermal Energy Heating or Coding Device It rest kit j - t f state.ZIP code my r v _ ^3 e.-1/..4,c).c.,v 0 i P )-1 NI \land 1 --zGo _ 00G • olo -021 • Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete as required by law,end Is prepared In accordance with IC 8-1.1-5.5.A person who knowingly and intentionality falsifies the value of � .._ _ _ . Page3of5 Y