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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
1
Under penalties of perjury, I hereby certify this Sales DIsclosUie, 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- 4c5:5. A person who knowingly and intentionally falsifies the value of transferred real property, or
omits or falsifies any information require to-be provided, commits a Level 5 felony.
Signature of Seller Signature of Seller
Printed Na e of er Date Signed (mm/dd/ Printed Name of Seller Date Signed (mm/dd/yyyy)
Brooke Traylor, Authorized Signer YYYY)
10/28/2025
J. BUYER(S)/GRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS — IDENTIFY ALL THAT APPLY1404
Buyer 1 - Name as it appears on conveyance document Buyer 2 - Name as it appears on conveyanc ocu
James Willis Oe
s6
Address (number and street) Address (number and str �2
1422 Club House Dr., A208 G�/� I�
City, State and ZIP Code �-
City, State and ZIP CodetiOY _ a.�,�
Columbia, TN 38401 'C/ ' V-4,18. _ .),,
Country CountryfY�
United States of America C�0
Email Address
for certain deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
RI ❑ 1. Will this property be the buyer's primary residence? EZ 0 3. Homestead
❑ El 2. Does the buyer have a homestead to be vacated for ❑ 121 4. Solar Energy Heating or Cooling System
this residence? If yes, provide address: 0 RI 5. Wind Power Device
Address (number and street) ❑ El 6. Hydroelectric Power Device
❑ 11 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County
it()- C -- '? - CC. 0 l .Ci4 11 r OC .
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
3 - 3 ,,
a.`y5.