Homestead_Brendel H. PREPARER
Preparer of the Sales Disclosure Form Title
Jamie E. Smith Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
101 Plaza East Boulevard, Suite 102, Evansville, IN 47715
I. SELLERS)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on con ment
Michael S. Fortenberry Mandy P. Fortenberry (((
Address(number and street) Address(number and street)
City,State,and ZIP Code City,State,and ZIP Code J N /
2424
Country Country
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E-mail Address Telephone Number E-mail Address Nc O J • T elephone Nu ber
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Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,Is true,coffQt?and complete as
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 any information required to be provided,commits a Level 5 felony.
Sig
nature of Seller Signature of Seller
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Printed Name of Seller Date Signed(mm/dd/yyyy) Printed Name of Seller pa(e_ Date Signed(mm/dd/yyyy)
Michael S Fortenberry June 4, 2024 Mandy P.Eprtenberry June 4, 2024
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
Maxwell K. Brendel Ashley L. Brendel
Address(number and street) Address(number and street)
504 S Old Patoka Road _ 504 S Old Patoka Road
City,State,and ZIP Code City,State,and ZIP Code
Patoka, IN 47666-9001 Patoka, IN 47666-9001
Country Country
YES/ NO CONDITION YES NO CONDITION
,..,j ❑ 1.Will this property be the buyer's primary El 3.Homestead
���QQQ residence? ❑ ,Er4.Solar Energy Heating or Cooling System
me 2. Does the buyer have a homestead to be vacated 0 ' 5.Wind Power Device
❑ for this residence? If yes,provide address: El 2.
Hydroelectric Power Device
Address(number anci street) ❑ 123/ 7.Geothermal Energy Heating or Cooling Device
1/ZI/W,45h,tiJc iatil AVE
State,ZIP code,and Connty.,
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and corfiplete
as 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 any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
information,SSN/Drlver's License/ID/Other Number Is necessary only if a Homestead Deduction Is being tiled.)
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