Homestead_Lewis (2) H. PREPARER
Preparer of the Sales Disclosure Form Title
Micah Scott Escrow Officer
Address(number and street,city,state,country,and ZIP Code)
7412 Eagle Crest Blvd. Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
on conveyan o�document
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears
Lance R. Davis ��
Address(number and street) Address(number and street)
n("7 E . S4_c..�c_ 5 k-re X -
City,state,and ZIP Code / J -7 A City,state,and ZIP Code �i,/ )
-Pr;Y1Cc-'�'ijh (=y� tN �[�O / V Count VG `
Country J IT Country
C'esOk '?o .,9
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 pre accordance with IC 6-1.1-5.5.A person who knowingly and Intentionally falsifies the value of transferred
real property,or omits alsifies a y information required to be provided,commits a Level 5 felony.
Si nature of Seller ���// Signature of Seller
a'A"'-' "
' ed Name of S Iler Date signed(mm/dd/yyyy)
Printed Name of Seller I Date signed(mm/dd/yyyy)
Lance R. Davis 07/11/2022
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
Travis R. Lewis
o(nu be,apd stet) IA /I_L��� 1 Address(number and street)
Ci state,a ZIP Code �^ 7 r City,state,and ZIP Code
rT lal yZIP ter:, h/Alp�6 y
Count J Country
v✓ ) Telephone number
E-mail address
for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary
p 0 3. Homestead
O 0 residence? 0 O 4. Solar Energy Heating or Cooling System
ra 2. Does the buyer have a homestead to be vacated 0 tEl 5.Wind Power Device
0 for this residence?If yes,provide address: 0 tEl 6.Hydroelectric Power Device
Address(number and street) 0 0 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county CG-!/ba-3o p _ OO ` 7 (p - d D 7
LAST 5 OF SSN:
Page 3 of 5
`rx