Homestead_Georges (9) H. PREPARER
Preparer of the Sales Disclosure Form Title
Abbigail Moers 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 Seller 2—Name as it appears on conveyance document
Mackenzie Rene Burgess,formerly known as Mackenzie Rene
Georges
A dress(number and street) Address(number and street)
l� /05? s Ec w
City,State and ZIP Code City,State and ZIP Code
L Dwp A 1/✓ y%76 5
Country Country
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.
Si natur of eller Signature of Seller
Printed Nalfl" of Sell Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Mackenzie Rene Burgess,formerly known 6/23/2022
as Mackenzie Rene Georges
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
Justus Georges
Address(number and street) Address(number and street)
10642 E. 700 S.
City,State and ZIP Code City, State and ZIP Code
Oakland City, IN 47660
Country Country
United States of America
E-mail address
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
p ❑ 1. Will this property be the buyer's primary residence? 0 ❑ 3. Homestead �T
❑ 0 4. Solar Energy Heating or Cooling Systrn�
❑ ❑ 2. Does the buyer have a homestead to be vacated for this 7 T ' ti �a
residence? If yes, provide address: ❑ 0 5. Wind Power Device ^
❑ 0 6. Hydroelectric Power Device N•
Address(number and street) ❑ p 7. Geothermal Energy Heating or Co vice Z -a
City,State,ZIP code, and county 7
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and completer-- c7
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
3 �::