Homestead_Brownell i H. PREPARER
Preparer of the Sales Disclosure Form Title
t Lana Harper Settlement Agent
1 Company m �T E-mail address
Address(number and street,city.state.country,and ZIP Code)
25 NW Riverside Drive,Suite 310,Evansville, IN 47708
;f I. SELLERS)/GRANTOR(S) Ii Seller 1 -Name as it appears on conveyance document ' Seller 2-Name as appears on conveyancedocument
Elsie I. Hornbeck Trust dated October 29,2002
Address(number and street) Address(number and street) 4 ,
317 W First St `V l✓ '• 00
41
City.state.and ZIP Code City,state,and ZIP Cod • !(/�•
Owensville, IN 47665 496,[1._ 'rCk -,
Country Country _'VC '/
US O��'�!�
E-mail address
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.
Si nature of Seller Signature of Seller
�,-�-. ,, 4 ilyOet-/eY4rd ci.i PLA
Printed Name of Seiler Date signed(mm/dd+yyyy) Printed Name of Seller I Date signed(mm/ddlyyyy)
Elsie I.Homback,Trustee 07/28/2023 1 07/28/2023
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
George Brownell Karen Brownell
Address(number and street) Address(number and street)
201 N 1st St 201 N 1st St
City,state.and ZIP Code ' City,state.and ZIP Code
Owensville, IN 47665 Owensville, IN 47665
Country F Country
US
mail address Telephone number
Pursuant to IC 8-1.1-12-4t,the Sales_ Disclosure Form may be used to apply for certain_deductions.Identify all of those that apel r�.
! YES NO CONDITION ���� YES NO CONDITION -
i 1.Will this property be the buyer's primary 1 ® 0 3.Homestead
® O residence?
0 ( 4.Solar Energy Heating or Cooling System
O y�,( 2. Does the buyer have a homestead to be vacated 0 l� 5. Wind Power Device
f\ for this residence?If yes,provide address: 0 [2 6. Hydroelectric Power Device
Address(number and street) p DJ 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county 9 1
pl ^` 7- 10 l-00O, 149 -022-
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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