Homestead_Weiss H. PREPARER
Preparer of the Sales Disclosure Form Title
Leah Brown Settlement Agent
Company
Address(number and street,city,state,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 Seiler 2—Name as appears on y document
Household Thoughts,L.L.C.
Address(number and street) Address(number and street) -441)
10890 S US Highway 41 ✓U
City,State,and ZIP Code City,State,and ZIP Code
Haubstadt,IN 47639 1 9
Country Country G/
US eSp
ti
penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,istru( sect,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.
Signature of Seller Signature of Seller
Printed Name of Seller Date Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
Brian S.Ellis, 07/12/2024 07/12/2024
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
Kevin R.Weiss
Address(number and street) Address(number and street)
407 W.Elm St.
City,State,and ZIP Code City,State,and ZIP Code
Haubstadt,IN 47639
Country Country
US
( )
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
® 1.Will this property be the buyer's primary ® 0 3. Homestead
residence? 0 ® 4. Solar Energy Heating or Cooling System
0 4. 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
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,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the value of
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