Homestead_Bates (3) H. PREPARER
Preparer of the Sales Disclosure Form 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. SELLER(S)IGRANTOR(S)
Seller 1 - Name as it appears on conveyance document Seller 2 Name as appears on conveyance document
Southern Indiana Home Investments LLC
Address (number and street) Address (number and street)
2416 Shannon Street
City, State, and ZIP Code City, State, and ZIP Code
Washington, IN 47501
Country Country
E-mail Address j Telephone Number E-mail Address I Telephone Number
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 any Information required to be provided, commits a Level 5 felony.
Signature of Seller Signature of Seller
Printed Name of Seller Date Signed (mm/dd/yyyy) Printed Name of Seller ' Date Signed (mm/dd/yyyy)
Anthony Lengacher, Member November 6, 2025 • •vember 6, 2025
J. BUYER(S)/GRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY • . TH • Ai•PLY
Buyer 1 - Name as it appears on conveyance document Buyer 2 - Name as it appears orpveyance = u e ,
a
Gabrielle R. Bates
_ �v�j_
Address (number and street) Address (number , et) C �D
West Columbia Street �S
311p t
City, State, and ZIP Code City. State, and ZIP CodP�,O
Oakland City, IN 47660-1411 &�r
Country — H Country ,9e./0� ,
T ,
E-mail Address
certain deductions. Identify all of those that apply:
YES NO CONDITION 1. Will this propertybuyer'sprimary rimary El[YES NO CONDITION
be the 3. Homestead
residence? n 4. Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated ❑ ( 5. Wind Power Device
❑ for this residence? If yes, provide address: ❑ bd 6. Hydroelectric Power Device
Address (number and street) ❑ 7. Geothermal Energy Heating or Cooling Device
City, State, ZIP code, and County 1 Qi, - Ik4 S?OO�,
1 000 . 883 - 004-
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
_- ,
,„Ise, or),Page 3
-r,-7 T
•
.,,,,
Page 3 ,