Homestead_Clarke H. PREPARER _
�---- — - ---- -
Prepare'of the Sales Disclosure Form I Title
Jamie E. Smith Escrow Officer
' Company
Address (number and street, city, state, country, and ZIP Code)
101 Plaza East Boulevard, Suite 102, Evansville, IN 47715
I. SELLERS)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document 7 Seller 2- Name as appears on conveyance document
Southern Indiana Home Investments LLC I -
Address (number and street) Address (number and street)
2736 South 300 West
City, State, and ZIP Code City. State, and ZIP Code
I Washington, IN 47501
Country — - Country' - --,
E-m • Address
U der penalti s of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge and belief, is true, correct and complete as
r quir d by I , and is prepared in accordance with IC 6-1.1-5.5. A person who knowingly and intentionally falsifies the value of transferred
al p ope or omits or falsifies any information required to be provided, commits a Level 5 felony.
ig er Signature of Seller
'411
P i Name f Seller Date Signed (mm/ddlyyyy) Printed Name of Seller Date Signed (mm/dd/yyyy)
nthony Lengacher, Member September 10, 2025 ber 10, 2025
J. BuYER(s)/GRANTEE(s) — APPLICATION FOR PROPERTY TAX DEDUCTIONS—ID417Y ALL
Buyer 1 - Name as it appears on conveyance document Buyer 2 -Name a • ppears on co,eyance docu tlii
I
Ethan Clarke _ _ Ella Mathis
Address (number and street) Address (number t'
223 South Main Street 223 South Main SA -Q
rOaklCity, State, and ZIP Code City, State, and ZIP Code ��
Oakland City, IN 47660
and City, IN 47660 .q
Country - —__ -— --- - -- Country -v/T0'
9
deductions. Identify all of those that apply:
YES NO CONDI-MT ON YES NO CONDITION
4 1. Will this property be the buyer's primary El3. Homestead
❑ residence? ❑ 4. Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated ❑ 5. Wind Power Device
Lifur this residence? If yes, provide address: , ❑ 6. Hydroelectric Power Device
Address (number and street) ❑ E" 7. Geothermal Energy Heating or Cooling Device
City. State. ZIP code. and County
I 6 - ly - I -ool . 22-7 - OO -
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
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