Homestead_Carlton 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 ance document
Scott A. Burr TandyY. Burr
Address(number and street) Address (number and street)
6639 W.Stonebead Dr. 6639 W. Stonebead Dr. ED
City, State and ZIP Code City, State and ZIP Code ✓(/Z
Owensville, IN 47639 Owensville, IN 47639 3 1 2023
r)
Country Country
United States of America United States of Am ,
E-mail address' Telephone number E-mail address COVQ 1 Telephon u
gUni..,aJ
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief, is true,cor7�t 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 falsifies any information required to be provided,commits a Level 5 felony.
Signature of Seller Signature of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Scott A. Burr 7/20/2023 TandyY. Burr 7/20/2023
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
Justin D.Carlton Summer Nicole Temme
Address(number and street) Address(number and street)
6639 W Stonebead Dr. 6639 W Stonebead Dr.
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
YES NO CONDITION YES NO CONDITION
1 ❑ 1. Will this property be the buyer's primary residence? 0 3. Homestead
G El 4. Solar Energy Heating or Cooling System
❑ 0 2. Does the buyer have a homestead to be vacated for 0 C4 5. Wind Power Device
this residence? If yes, provide address:
0 0 6. Hydroelectric Power Device
Address(number and street) ❑ M 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code,and county / _ 17_ v / 1 y02 -COI/ , 1
r co -CQ(
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
Page 3
-. I C 0 PY