Homestead_Payne (2) H. PREPARER
Preparer of the Sales Disclosure Form Title
Kandace Rogers Closing Agent
Company
Address(number and street,city,state,country,and ZIP Code)
4905 Theater Drive, Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Blair A. Lamey
Address(number and street) Address(number and street)
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State,and IP Code City,State,and ZIP Code
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Country Country ilf4R 02
USA 202f
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Lyazis
C)4/C_O C?
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge correct and complete as
required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentlidiail& .
the value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Signature of SellerSignature of Seller
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Printed Name of Setter Date Signed(mm/dd/yyyy) Printed Name of Seller ' Date Signed(mm/dd/yyyy)
Blair A. Lamey February 23, 2023 February 23, 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
Nickolas Payne Ashley Payne
• Address(number and street) Address(number and street)
I
107 East Poplar Street
107 East Poplar Street
1 City,State,and ZIP Code City,State,and ZIP Code
Fort Branch, IN 47648 Fort Branch, IN 47648
Country Country
USA USA
1---1 1.Will this property be the buyer's primary El 0 3. Homestead
1:11 LI residence? El 1:1 4.Solar Energy Heating or Cooling System
CI .„, ..-2.Does the buyer have a homestead to be vacated El El
a,mb• ,for this residence? If yes,provide address: 5.Wind Power Device
El El 6.Hydroelectric Power Device
Address(number and street) Ell 0 7. Geothermal Energy Heating or Cooling Device
City,State,ZIP code,and County - I 'S -eili—fiz 9-ow . oqo - o U.
Under penalties of perjury,I hereby certify that 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
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