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Homestead_Hines 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.SELLER(S)/GRANTOR(S) Seller I—Name as it appears on conveyance document Seller 2-Name as appears nveyance document Willie Marie Solomon Trust Irss(,�urggeran street \ Address(numberand stye �rn\Ii 6 Ciyy; t tm P`CSod5 4._ 41 City,state,and ZIP Code -- ,b . Country 4061 . �v} Country U / I USA USA cua- best of my knowledge ar `�� e,correct and complete as required by law,and Is prepared in accordance with IC 6.1.1-5.5.A person who knowingly and Intents i es the value of transferred real property,or omits or falsifies any Information required to be provided,commits a Level 5 felony. ©/)- Sign u o e�• —y1 Signature of Seller OR �._ Prin ed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy) Clifford Oliver, II,Successor Trustee C—)— iZ— -.,?..S.-- 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 Alexis Ann Hines Address(number and street) Address(number and street) 203 S Center St City,state,and ZIP Code City,state,and ZIP Code Princeton IN 47670 Country Country 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 CONDITION YES NO CONDITION 0 O 1.Will this property be the buyer's primary O 0 3.Homestead residence? 0 D 4.Solar Energy Heating or Cooling System O V2.Does the buyer have a homestead to be vacated 0 D 5.Wind Power Device for this residence?If yes,provide address: O D 6.Hydroelectric Power Device Address(number and street) 0 t 7.Geothermal Energy Heating or Cooling Device City,state,ZIP code,and county (%---11 — 12-1402-002. l T8 —a 28 j i Page 3 of 5 +'`,1'1 j. x a r I