Homestead_Botzum (2) H. PREPARER
Preparer of the Sales Disclosure Form Title
Steven T.Charles Attorney
Company
Address(number and street,city,state,country,and ZIP Code)
4828 Lincoln Ave., Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Edward Botzum Annlee Botzum
Address(number and street) Address(number and street)
2061 E SR 68 2061 E SR 68
City,state,and ZIP Code City,state,and ZIP Code
Haubstadt, IN 47639 Haubstadt, IN 47639
Country Country
USA USA
E-mail address
Under penalties of perjury,I hereby certify 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.
Signature of Seller -Sig re of Seller /
tr�/,�Q n�
Printed Name of Selle Date signed(mm/dd/yyyy) Prin ed Name of Seller Date signed(mm/dd/yyyyj
Edward Botzum 02/11/2022 Annlee Botzum 02/11/2022
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 appears on conveyance document
Chris
ddr J.Botzum
(numbs FILED
Address(number and street) Address(number and street)
2061 E SR 68
City,state,and ZIP Code City,state,and ZIP Code
Haubstadt, IN 47639 APR 0 5 2027
Country Country
USA t�7_ '�_,�'Y,a•.'na)
E-mail address
apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary El 0 3.Homestead
0 0 residence? 0 n 4.Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated I 0 0 V' nd Power Device
0 0 for this residence?If yes,provide address: I 0 El 6.Hydroelectric Power Device
Address(number and street) 0 0 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county I 0(h^ca r 09-'20O-0 00 f 5y5-oeR l 1 .