Homestead_Kirslis (2) •
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
Elite Companies, Inc., an Indiana Corporation
Address (number and street) Address (number and street)
304 E SR 68
City, State and ZIP Code City, State and ZIP Code
Haubstadt, IN 47639 ,
Country Country
United States of America
Under penalties of perjury, I hereby certify this Sates 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.
Si nature of Sell Signature of Seller
Printed Name of Seller Date Signed (mm/dd/ Printed Name of Seller Date Signed (mm/dd/yyyy)
Dona Brown, Authorized Signer YYYY)
9/22/2025 /'- .,
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 convey' nce document
Daniel Michael Kirslis 6 .-/-i
Address (number and street) Address (number and reet) �,
820 S. Stormont St. ?025
City, State and ZIP Code City, State and ZIP CF,61e .
Princeton, IN 47670 , Co ilr4S--L)
Country Country /�"b �`
United States of America '410�/T�aJ
.
Email Address
deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION pf,
:lee ❑ 1. Will this property be the buyer's primary residence? El ❑ 3. Homestead1,1' w
❑ 2. Does the buyer have a homestead to be vacated for ❑ El 4. Solar Energy Heating or Cooling System
this residence? If yes, provide address: ❑ El 5. Wind Power Device
Address (number and treet) :3_() - 1 Z�'1 S-ZO2 _ ❑ El6. Hydroelectric Power Device
Qc o g r o C+. 0O 2 Oq $_0 24 0 El 7. Geothermal Energy Heating or Cooling Device
ity, State, and ZIP Code County ,v G'bson -0- ( - 13- l oc)-- 0014 . LA°(---1 — S
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
License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
3