Homestead_Michael H. PREPARER
~Preparer of the Sales Disclosure Form Title y
Kris L Coon Escrow Officer
Company
Address (number and street, city, state, country, and ZIP Code) •
4600 Washington Avenue, Suite 102, Evansville, IN 47714
I. SELLERS)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Donnie E. Breeden Tammy Breeden
Add es (number sire dr S u and str etJ
t .ftl*if
OLy\ WAhitY*
Cit e, and Z ode y, and ZIP C e
-)Y\ C-eVir\ id 4-1L51.0 _
Country Count
USA USA
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 o1 SeerSi{ nature of Seller
4"\ ‘- p4.eEel- -- Lk i'1-66/1___)
Printed Name / eller Dale yyyy) Printed Name of Her G : hr• Jr ��ddiyyyy)
Donnie E Breeden — OeCembei t- , 2U25--- Tammy Breeden _ ,
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
Michael Michael Emita Loem Bungitak
Address (number and slreel) jr,
, � II.GTe..v rr rJ -- - ___4
,--_-3 l -KA- (Sk--
City, State, and ZIP Code City, St and Zf Cc e_ _ 1,IN .i 466 Lol
-C-Yef464illerit t\Ceil*k 1.A 4°h6-P
fi.._)
Country Country --'
USA USA
YES NO CONDITION YES O CONDITION
7 1. Will this property be the buyer's primary n 3. Homestead
❑ resi once? ❑ (� 4. Solar Energy Heating or Cooling System
. Does the buyer have a homestead to be vacated E 5. Wind Power Device
0 for this residence? If yes, provide address: 6. Hydroelectric Power Device
Address (number and street) [J El 7. Geothermal Energy Heating or Cooling Device
City, State, ZIP code, and County r 2 �1—
�O 2 - I - 0745
t
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
Pape 3
J A N 2 2 2026
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GIBSON COUNTY AUDITOR