Homestead_Mullis H. PREPARER
Preparer of the Sales Disclosure Form Title
Amy B.Pollard Settlement Agent
Company
Address(number and street,city,slate,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
Agape Church of the Nazarene, Inc. ( +� � ���
Address(number and street) Address num r n sEe
601 S Lincoln Street
City,State,and ZIP Code City, t e,and ZIP Code
pk
Fort Branch, IN 47648
Country CounGryBSUN COUNTYAUDITOR
US
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 information required to be provided,commits a Level 5 felony.
Signature of Seller Signature_of� Seller VN C1 Ak
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Prime Date Signed(mmldd/yyyy) Printed Name o eller Date Signed(mm/dd/yyyy)
Bryan Holzappel, 06/12/2023 ;.'. ,4 k \a r\ 06/12/2023
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
Kevin Mullis Joan Gardiner
Address(number and street) Address(number and street)
201 W 12th Street 201 W 12th Street
City,State.and ZIP Code City,State,and ZIP Code
Benton,KY 42025 Benton,KY 42025
Country Country
US US
YES NO CONDITION YES NO CONDITION
O 1.Will this property be the buyer's primary ® 0 3. Homestead
residence? O ® 4. Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated 0 ® 5.Wind Power Device
for this residence? If yes, provide address: 0 ® 6. Hydroelectric Power Device
Address(number and street) 0 ® 7. Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County 6 r
lq-\q -toi -000.60 g-0 2C
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