Homestead_Burnes H. PREPARER
Preparer of the Sales Disclosure Form Title
pail
Escrow Officer
Co Moers
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
Julie Renee Caanan
Timothy Ray Brubaker
Address(number and street) Address(number and street)
9
9292E 600 S 292E 600 S
City,State and ZIP Code City,State and ZIP Code
Oakland City, IN 47660 Oakland City, IN 47660
Country
Country
United States of America United States of America
�
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,ccrra
is a Level 5 felony. ®�
gnat of, - (:igna of ,el er/u /" "`
� )) J Date signed(mm/dd/yyyy) `Printed Name of Seller !� I Date signed(mm/dd/yyyy)
Timothyted Rayy • ) a 6/29/2022 Julie Renee Caanan
Timothy Bruba er
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 d nt
Carla Marchelle Burnes 1�Address(number and street) Address(number and street)
9292 E.600 S. 9292 E.600 S. ✓��
, ,,..e)
City, State and ZIP Code City, State and ZIP Code Cie
Oakland City, IN 47660 Oakland City, IN 47660 0 crew
Country c0(i Q
Country USA T�'` ,
United States of America one numb
E-mail address Telephone number E-mail address PTO"
I (423) 280-0125 '9
Pursua to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for cc rtain deductions.Identify all of those that apply:
YE NO CONDITION YEyV NO CONDITION
0 Will this property be the buyer's primary residence? L' 0 3. Homestead
0 RI 4. Solar Energy Heating or Cooling System
0 I 2. Does the buyer have a homestead to be vacated for this 0 0 5. Wind Power Device
residence? If yes,provide address: ❑ RI 6. Hydroelectric Power Device
Address(number and street) 0 0 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county
U- Z. 8 5- -OO l
2-0 -to-moo—oo
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
' 5 `'