Homestead_Payne (3) Preparer of the Sales Discl ure. Form i Title -,,.-_
l r ox (1Je11.1 . I 5-en/id-et-
Company _ -.
Address(number and street.city.state.country.and ZIP Code)
7820 Eagle Crest Blvd,Suite 201,Evansville.IN 47715
1. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Marilyn S.Hurt
Address(number and street) Address(number and street)
6684 W North Street _. --- - ____.__._.___-..
. City.state.and 2IP Code City,slate.and ZIP Code
Owensville.IN 47665 -- - - ------
_Country ---.__- Country
US
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. ___-_ I
..Signature opf Seller ! i3p i Signature of Seller
noted N tc of Se: c �`' ate ned rrrudct`YYS'Y1 Printed Name of Seller Date signed(mrnldd'>YYY)
Marilyn S.Hurt 03/02/2,22 I 03/O2/2022
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 appeap v arce m al
Larry Payne
Address(number and street) - Address(number and street) qr�
606 Water Tower Road -_-_...__.- MAil__0 7 2022----- -.-__-_..--
City.stale.and ZIP Code City.state.and ZIP Code
Owensville,IN 47665 ihiz.kgz •
Country Country.
US GIBBON AUDITO
Email address
for certain deductions Identify all of those that apply:
N
YES NO CONDITION YF„5 NO CONDITION
Will this property be the buyers primary
residence? `/
IpL D 3.Homestead
a XaZ 4.Solar Energy Healing or Cooling System
2.Does the buyer have a homestead to be vacated 0 5.Wind Power Device
for this residence?It yes.provide address: 0 6.Hydroelectric Power Device
i
..
Address(number andnd street) 0 7-Geothermal Energy Heating or Cooling Device
City.slate,ZIP code.and county 6-1 / p 1_I•00-0 fog-S O-, 6 2_1
Under penalties of perjury,I hereby certify that this Sales.Disclosure.to the best of my knowledge and belief,is true.correct and complete
copy