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Homestead_Nelson H. PREPARER Preparer of the Sales Disclosure Form Title Angela J. Moers 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 Lonny Hofmann Pamela Kebortz Address(number and street) Address(number and street) 5800 Martin Road 5800 Martin Road City,State and ZIP Code City,State and ZIP Code Newburgh, IN 47630 Newburgh, IN 47630 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 a y information required to be provided,commits a Level 5 felony. . n re er X4ire of Seller Pr' t ame eller D9tp Signed(mm/dd/ yy) Printed Name of Seller Date igned mm/dd/yyvy) Lonny Hofm n 16 [A�! Pamela Kebortz 417,M5 J. BUYER(S)/GRANTEE(S) APPLICATION FOR PR PERT1 TAX DEDUCTIONS—IDENTIFY ALL THAT APPLY Buyer 1 —Name as it appears on conveyance document Buyer 2—Name as it appears on conveyance document Matthew T. Nelson Tiffany A. Nelson Address(number and street) Address(number and street) PIt10153SSR57 10153SSR57 Ci State and ZIP Code City,State and ZIP Code j City, /, Elberfeld, IN 47613 Elberfeld, IN 47613 "��1) Country Country OR 3 11 United States of America United States of America ?©s Email Address 0/eSp .(12) 2 6-1811 Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those --. . YES NO CONDITION YES NO CONDITION '104. 0 0 1. Will this property be the buyer's primary residence? 0 0 3. Homestead 0 0 2. Does the buyer have a homestead to be vacated for this ❑ 0 4. Solar Energy Heating or Cooling System residence? If yes,provide address: 0 0 5. Wind Power Device Address(number and street) 0 0 6. Hydroelectric Power Device 0 0 7. Geothermal Energy Heating or Cooling Device City,State,and ZIP Code County a2 , 02D— nz-gOD__coo, q./d—6e/ 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 transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's information,SSN/Driver's Page 3 4. "c"t5r r�yK 7y