HomeMy WebLinkAboutHomestead_Burgess (4) H. PREPARER
Preparer of the Sales Disclosure Form Title
Matthew Jarvis 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
Devyn R. Bailey Krimson R. Bailey
Address (number and street) Address (number and street)
2532 S. Old State Rd.65 2532 S. Old State Rd. 65
City, State and ZIP Code City, State and ZIP Code
Owensville, IN 47665 Owensville, IN 47665
Country Country
United States of America United States of America
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 fal ifies any information required to be provided, commits a Level 5 felony.
igna e o Sell v6ign t e of Selle
in ed N Se r Date signed (mm/dd/yyyy) Printame of Seller Date signed (mm/dd/yyyy)
Devyn R. Bailey 10/7/2022 Krimson R. Bailey 10/7/2022
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 eyance document
MacKenzie R. Burgess ��
Address (number and street) Address (number and street) 4
4058 S 600 W
City, State and ZIP Code City, State and ZIP Code C.-1
22
Owensville, IN 47665 8eo
Country Country ce`ON '
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
Ell 0 1. Will this property be the buyer's primary residence? 0 ❑ 3. Homestead
❑ 2 4. Solar Energy Heating or Cooling System
0 2 2. Does the buyer have a homestead to be vacated for ❑ 0 5. Wind Power Device
this residence? If yes, provide address:
❑ 0 6. Hydroelectric Power Device
Address(number and street) ❑ El 7. Geothermal Energy Heating or Cooling Device
City, State, ZIP code, and county c' 0_ D2
6 ^i (- o- ago
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3 COPY