HomeMy WebLinkAboutHomestead_Burgess (5) Prepares of the Sales Disclosure Form Title
Jamie E. Smith Escrow Officer
Company E-mail Address . Telephone Number
True Title Service, LLC jamie@truetitlein.com • (812)453-2559
Address(number and street,city,state,country,and ZIP Code)
101 Plaza East Boulevard, Suite 102, Evansville, IN 47715
..';I:. SELLER(s)/GOANtok( )" ,:;---:•-.,. . .%,:., ;5.,::!!,;,.:,::::": .:.:,,•', :.,.':.•-44.• .:,..:E.:-„,•r,,- :-:::.::,: ::, : :?:.:.i,.,•„::::•.!? :••••...,..T,, ,-•: :::,.:,.-., ..: ;]:,,.,::,?:,;,::.,,?1::w.,. ,i,:. ,,....:;::::,;:; .:•:!:•1,
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
AUSTIN O'RISKY REBEKAH O'RISKY
Address(number and street) Address(number and street)
512 N Polk Street 512 N Polk Street
City,State,and ZIP Code City,State,and ZIP Code
Fort Branch, IN 47648-1020 Fort Branch, IN 47648-1020
Country Country
E-mail Address Telephone Number E-mail Address Telephone Number
ajorisky@gmall.com (812)483-9884 Rebekah.leanne14@gmail.com (812)453-9206
Under penalties of perjury, Sales71316Cloaure,'to thii'best of my knowledgeandlbelief,lslidec.:dOrrect:40-completeaS-.:
required by lawandis::prePared inaccordan*withiGl6-1.14.5.A.PersOn Who knowingly and intentionally falsifies the value of
real prOperty,.or;ornits:orfaleifleaanYInforination;required•to.be Provided;Commits'a'LeverS felony.l.:l.11,:. '::::'; ;;'-'::':':': ,::::,,:l'l'''':3:.:::l••:;''::::: ::;'',l.
Signature of Seller // Signature of Seller .-
N. ktieL, 04,4;
inted Name of Set Date Signed(mmicid/yYyy) Prin ed ame of ell Date Signed(mrakid/yyyy)
AUSTIN O'RISKY May 30, 2023 REBEKAH()RISKY May 30,2023
J. Bpsivpwpo.4kT-E (o)..4Appf..!icNtjcikowp,Ror*,r3T..yT ::.pp*pTJONP-,4iAljOIT!F,YALI-;Itfl 'APPIYYA:rF4;n5
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as it appears on conveyance document
DELANIE BURGESS KYLE HODGES •
Address(number and street) Addresgnumber and street) •
.512 N Polk Street 512 N Pb*Street
City,State,and ZIP Code City,State,a?\I ZIP Code
Fort Branch, IN 47648-1020 Fort Branch, IN 47648-102'02 '
Country Country
E-mail Address Telephone Number E-mail Address Telephone Number
...,
(812)453-0608 • 11 -44.c.3 -0(o 0?)
;`Pursuant tolltl64.14Z44thelSales Disclosure FOrrif:rriaybelissed tolapply feraettairi:dedtiatiOnS:.l identifyall:of: oseAhataPplYlV:::,:l,:l :
vs NO CONDITION YES/ N6 CONDITION
r-i 1.Will this propert eit r's primary,4ipe Di, 3. Homestead
37:111 L-I residence? ..4.N 0 1191 4.Solar Energy Heating or Cooling System
0 5212.Does the buyertge a hom t a!AL.e vacated El zr
for this idence? lryetfrovide - .celr: 5.Wind Power Device
0 Er 6. Hydroelectric Power Device
Address(number angtt <17Q El d 7.Geothermal Energy Heating or Cooling Device
04,0
City,State,ZIP code,and Cotkityc'
1, 8 - a —14°1 - 000 612-02-C,
:Under penalties of PerjurSr,lfhereby, ;40. *, ,s.t:thia Sales'DISclOSure;to the best of my knowledge and belief,is true,correct and complete
as required by law,and Is prepared In a Eirk ance with 6-1.1,55;A person who 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 (Note Both spouse's
•informatton,-SSN/Driver's LicertsefiD/Other Number is necessary only If a Homestead Deduction:Is:being filed.)':-':,::':-. - :::,' •.:-.-. . ,H.-:.
Signature of Buyer 1
A/0-1!))/No 4)--Gilph-, /3o/ -7'` 3 1\
\ B ,i-Simr.. tif Buy 2/Spouse
Printed Legal Name of Buy 1 Sign Date(MANDE:WY) Primed Legal Nam of Buyer 2/Spouse Sign Date(MMIDD/YY)
DELANIE BURGESS May 30, 2023 KYLE HODGES May 30, 2023
la.st 5 i s of Buyer 1 SSN/Drivesis
tV.It\.‘59 t Inse/ID/0therur Last 5 ofBuepouse SSNnr'sLinseirteiyber
%f\-1. A \ Ai License!
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