Homestead_Willoughby 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 I 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 -1(....:46.46
Haubstadt, IN 47639 ✓'44/
Country
Country ��
United States of America Qi ?O4
perjury, I hereby certify this Sales Disclosure, to the best of my knowledge and belief, is true, tog nd 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 d rred real property. or
omits or falsifies any information required to be provided, commits a Level 5 felony. 9
Signature of Seller Signature of Seller
Printed Name of Sel Date Signed (mm/dd/ Printed Name of Seller ) Date Signed (mm/dd/yyyy)
Phillip VI/ Reinbrecht, President YYYY) i
12/23/2025
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 conveyance document
Dillon Scott Willoughby Mckayelah Willoughby
Address (number and street) Address (number and street)
736 Oak St. 736 Oak St.
City, State and ZIP Code City, State and ZIP Code
Bicknell, IN 47512 Bicknell, IN 47512
Country Country
United States of America United States of America
Email Address
YES NO CONDITION YES NO CONDITION
Z ❑/k1 . Will this property be the buyer's primary residence? 7 iJ 3. Homestead
❑ Cal 2. Does the buyer have a homestead to be vacated for 0 Q 4. Solar Energy Heating or Cooling System
stem
this residence? If yes, provide address: ❑ El 5. Wind Power Device
Address (number and street) ❑ El 6. Hydroelectric Power Device
❑ El 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County C\ 11 r r
5i 0
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 rea