Homestead_Shafer (2) H. PREPARER
rPreparer of the Sales Disclosure Form Title 1
Jamie E. Smith Escrow Officer
Company
� �
-Address (number and street. city. state. country, and ZIP Code) i
101 Plaza East Boulevard, Suite 102, Evansville, IN 47715
I. SELLERS)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document Seller 2 -Name as appears on conveyance document
Hoosier Homes and Hospitality LLC
Address (number and street) Address (number and street)
3111 Bellemeade Avenue
City, State, and ZIP Code City, State, and ZIP Code
Evansville, IN 47714
Country - -- — Country - - — —
3
E-mail Address —
a Level 5 felony.
Signature f SellerX
ted Signature of Seller
,2_����
Namd of elle Date Signed (mrn/ddlyyyy) Printed Name of Seller 1 Date Signed (mm/ddlyyyy)
Nicholas Sellers, Member December 5, 2025 December 5, 2025
J. BUYER(S)/GRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY HAT, • 'LY
Buyer 1 -Name as it appears on conveyance document Buyer 2 -Name as it appears on conveya .'' : t
Brooke Shafer - -
Address (number and street) Address (number and street) DE-`
525 Meadowlark Drive / 6
City, State, and ZIP Code City, State, and ZIP 4 `�'
Princeton, IN 47670-8841 G1
Country Country N e CO
E-mail Address
NO CONDITION
1 . Will this property be the buyer's primary 03. Homestead
❑ residence? ❑ Or4. Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated El lam' Wind Power Device
Y❑ for this residence? If yes, provide address: ❑ E2,/ 6. Hydroelectric Power Device
Address (number and street) ❑ D 7. Geothermal Energy Heating or Cooling Device
City, State. ZIP code, and County N -V2----)
C .1 O I _00 1 • 19l , - 0 2
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
/