Homestead_Vertein 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. SELLERS)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as it appears on conveyance document
Southern Indiana Home Investments LLC,an Indiana limited liability
company
Address(number and street) Address(number and street)
2736 S 300 W
City, State and ZIP Code City, State and ZIP Code
Washington, IN 47501 ,
Country Country
United States of America
/ .
Under pe,all-s of perj/ ,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,is true,correct,and complete as required
by law, .nd i prepare in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the value of transferred real property,or
omits •rfal;ifies an ./formation required to be provided,commits a Level 5 felony.
r
„*Si• at j 2J, i•J Signature of Seiler
r ri r •• am- of,..ler Date Signed(mm/dd/ Printed Name of Seller 1 Date Signed(mm/dd/yyyy)
' thony Lengac er,Member YYYY)
2/10/2025
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIF T LY ,
Buyer 1 —Name as it appears on conveyance document Buyer 2—Name as it ear o co n 11;1 ument
Daren Vertein
Address(number and street) Address(number and str
749 N Coal Mine Rd r B 13 2025 -4
City, State and ZIP Code City, State and ZIP Code
Princeton, IN 47670
Country Country GIBSON C C
d-446n, ,
United States of America OUNn'AUDIT
for certain deductions.Identify all of those that'apply: ilk
YES NO CONDITION YES NO CONDITION
lI ❑ 1. Will this property be the buyer's primary residence? El 0 3. Homestead j
❑ 12. Does the buyer have a homestead to be vacated for 0 ❑ 4. Solar Energy Heating or Cooling System
this residence? If yes, provide address: 0 El 5. Wind Power Device ,
Address(number and street) 0 RI6. Hydroelectric Power Device
0 ,El 7. Geothermal Energy Heating or Cooling Devi =
City, State,and ZIP Code County
a(p--f' F 401 oo f, 2ctb 001
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct,and complete