Homestead_Payne (4) H. PREPARER
Preparer of the Sales Disclosure Form Title
Kris Coon Closing Agent
Company
Address(number and street,city,state,country,and ZIP Code)
4600 Washington Ave., Suite 102, Evansville, IN 47714
I. SELLERS)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Abner Homes and Contracting LLC
Address(number and street) Address(number and street)
8572 Indiana 65
City,state,and ZIP Code City,state,and ZIP Code
Hazelton IN 47640 Pi
Country Country
USA --4-.6.
is prepared in accordance with IC 6-1.1-5.5.A person who knowingly .'' .a I I.nally falsifies the value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 -
Signature Seller Signature of Seller .�Q
Printed Name of Seller Date signed( m/ddiyyyy) Printed Name of Seller fate signed(mmlddlyyyy)
Derek Abner (o /..2-1 q..f
J. BUYER(S)/GRANTEE(S)-APPLICATI N F R 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
Tymothy Payne
A ri(n beta0d s t i Address(number and street)
S;.—
comawro City,state,and ZIP Code
Country Country \�)
USA
for certain deductions.Identify all of those that apply:
YES NO CONDITION ;V NO CONDITION
V0 1.Will this property be the buyer's primary 0 3. Homestead
residence? 0 4.Solar Energy Heating or Cooling System
0 , /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 'N 7. Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county J�d(
n 6 -- 12-01- - 403 -002_ - v4R--02$
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete
4,