Homestead_Love H. PREPARER
Praoarer of th 5Saes Disclosure Form Title
S the
tacey a`zman Settlement Agent
Company
Address(number and street,city,state,country,and ZIP Code)
2301 N.Burkhardt Road,Evansville,IN 47715
I. SELLERS)/GRANTOR(S) •
_
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyanc c ant
Marc Kent Johnson �A
Address(number and street) Address(number end street) .494/
219 E.2nd St. ,J► //
City,state,and ZIP Code City.state.and ZIP Cotyy Z
Oakland City,IN 47660 '`SOt, O�..?
Country Country C'O�Q
US '�')i e�
E-mail address
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.
gignatu7A?eller % > Signature of Seller
VV11�� //���CCVL-c� J�(a n
Printed Name of Seller Date signed(mm/ddlyyyy) Printed Name of Seller Date signed(mmldd/yyyy)
Marc Kent Johnson 01/31/2023 01/31/2023
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
Amanda D.Love Chase Tyler Jefferys
Ad. ess.(n ber en )( C Address(numb�nd street)
C y, _; . an IPio de City state,and ZIP Code
C- ' , -C_C',-- C-
Country t L 11 0() Country
pply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
CD1.Will this property be the buyer's primary ® 0 3.Homestead
residence? 0 G9 4.Solar Energy Heating or Cooling System
® 2.Does the buyer have a homestead to be vacated 0 1 5.Wind Power Device
(or this residence?IT yes,provide address: 0 ® 6.Hydroelectric Power Device
~Address(number and street) 0 C4 7.Geothermal Energy Heating or Cooling Device
City,state.ZIP code.and county
(- jcl -) S2 - 2-03 - 600. 4-1-11 — oo4- •
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the hest 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
copy