Homestead_Ashby (3) 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
Mission Real Estate Group Inc
Ad nu/ c iij st� �\� Address(number and street)
C" t , (1d P C-oleW t cli�� City,state,and ZIP Code
Country 1 �vJL�i vl Country
USA USA
( )
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 acc rdance with IC 6-1.1-5.5.A person who knowingly and Intentionally falsifies the value of transferred
real property,or its or lies formation required to be provided,commits a Level 5 felony.
Signature of A Signature of Seller PI
Printed N e of Seller Date signed(mr�/dd/yyyy) Printed Name of Seller igned /dd/yyyy)
Jame M.Chappe , President vZ a$A 5
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY� HAT APPL
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as It appear on conveyar&carment
Jasmine Ashby r ?Qa
-,.Ag(itUthbe street) Address(number and streQjeS
C e,a�d -Pod�e[�, cf.'�{i ,. City,state,and ZIP Code �CO�/
Country Country C2:r47 v/7OA
USA USA
( )
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%,, ONDITION YEES/NO CONDITION
\N�(/ / 1.Will this property be the buyer's primary �f' 0 3. Homestead
re 'dence? 0 V 4.Solar Energy Heating or Cooling System
.Does the buyer have a homestead to be vacated 0 5.Wirid Power Device
i
for this residence?If yes,provide address: 0 i 6. Hydroelectric Power Device
Address(number and street) 0 ( 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county �ZD I-O '3 —022
26-12-07 -
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