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Homestead_Harwell H. PREPARER Preparer of the Sales Disclosure Form Title Matthew Jarvis Escrow Officer Company Address (number and street, city, state, country, and ZIP code) 605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713 I. SELLER(S)/GRANTOR(S) Seller 1 -Name as it appears on conveyance document Seller 2-Name as it appears on conveyance document Miguel Mejia Ayala Alfredo Americo Umanzor Ruiz Address (number and street) Address (number and street) 208 A North Van Buren 208 A North Van Buren City, State and ZIP Code City, State and ZIP Code Huntingburg, IN 47542 Huntingburg, IN 47542 Country Country United States of America United States of America Email Address Under penalties of perjury, I hereby certify 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 transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony. `,Signat re of Sel er , ,,Signature of Seller Printed ame of Seller Date Signed (mm/dd/ Printed Name of S Date Signed (mmldd/yyyy) Miguel Mejia Ayala YYYY) Alfredo Americo ma or Ruiz 9/11/2024 9/11/2024 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 conveya ocument Adrienne Harwell It Address(number and street) Address (number and street) 5344 S State Road 61 �. -� City, State and ZIP Code City, State and ZIP Code Fp1 Winslow, IN 47598 , c,4 a 1 Country Country 604: - �I� United States of America ONj,� , /TOo 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 IZ ❑ 1. Will this property be the buyer's primary residence? © ❑ 3. Homestead n cam: / ❑ © 4. Solar Energy Heating or Co'oli i ys pr,rj• ❑ [f�7 2. Does the buyer have a homestead to be vacated for 1s' ='•� `l ❑ E 5. Wind Power Device y, ;. this residence? If yes, provide address: ❑ p 6. Hydroelectric Power Device Address number and streetis ( ) ❑ © 7. Geothermal Energy Heating or Cooling Device City, State, and ZIP Code County ©©O` �� �oc 7 ��� 4o—/�/s'-403 —