Homestead_Couts (3) •
H. PREPARER
Preparer of the Sales Disclosure Form Title
KATHY MASTERSON CLOSING AGENT
Company
Address(number and street,city,state,country,and ZIP Code)
501 MAIN STREET, Evansville, IN 47708
I.SELLERS)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document ---%
Douglas J.Chambon Christy J.Chambon
—
r_esr(number and street)• ; y Address^(n�umyb�err and street) �j
City,' tate,and ZIIAP"CALoAdWter��a* tilt
! ,5T1 1 i Y l 0 Y fl I VI S t di D r.
ih- �� � w ��� City,
�state,
.and ZIP Code Cou� ' ` 4 Count v11buIv, N 141 t�3 0
USA `J USA Country
E-mail address
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 pro rty,or omits or fats es any Information required to be provided,c remits a Level 5 felony.2
j���
Signa of Seller '"- to f Sel 0,0 �/t/ `�
Printed Name f Sell r Date signed(mm/dd/yyyy) Printed Name el Date signed(mm/dd/yyyy)
Douglas . Chambon 02/19/2021 Christy J. Chambon 02/19/2021
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
Tyley W.Couts Teri L. Couts
Address(number and street) Address(number and street)
7440 Rich Lynn Dr. 7440 Rich Lynn Dr.
City,state,and ZIP Code City,state,and ZIP Code
EVANSVILLE, IN 47712 EVANSVILLE IN 47712
USA Country Country
USA
E-mail address
applg'.
YES NO CONDITION YES NO CONDITION W
✓ 3.Homestead �'❑ 1.Will this property be the buyer's primary ❑ O �
residence? ❑ ✓❑ 4.Solar Energy Heating or Cooling Systo N H
a ❑ 2.Does the buyer have a homestead to be vacated 11
❑ ❑✓ 5.Wind Power Device z N N
for this residence?If yes,provide address: No
❑ ❑✓ 6.Hydroelectric Power Device N
D ry
Address(number and street) El El 7.Geothermal Energy Heating or Cooli4 ' e V
7440 Rich Lynn Dr.
City,state,and ZIP Code CountyO
73
EVANSVILLE, IN 47712 VANDERBURG 26-17-01-400-003.843-021
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