Homestead_Burton H. PREPARER
Preparer of the Sales Disclosure Form Title
Megan Boger Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
7412 Eagle Crest Blvd Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conveyan o
Household Thoughts, LLC
Address number and street) Address(number and street)
1�Y10 SUS 4h1...‘ 4 ‘ 4&6. `'6,/)
City,state,and ZIP Code City,state,and ZIP Code . 0
Vj bS—G(�, IN `--1--1 l93 C\ % 3 4
Country Country ti
us us CO c
E-mail address
of my knowledge and belief,is true,corr6}yt 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
re I property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
S nature of Seller Signature of Seller
ri ted Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Brian S. Ellis Member 07/31/2023
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
Heather A. Burton
Address(number and street) Address(number and street)
1005 South Lincoln Street
City,state,and ZIP Code City,state,and ZIP Code
Fort Branch, IN 47648
Country Country
US US
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
0 1.Will this property be the buyer's primary O 0 3. Homestead
, O O residence? 0 J 4. Solar Energy Heating or Cooling System
no
O 2. Does the buyer have a homestead to be vacated 0 Cl 5.Wind Power Device
er for this residence? If yes,provide address: O O 6. Hydroelectric Power Device
SAddress Inumber and street) 0 f 7.Geothermal Energy Heating or Cooling Device
O looS S . L,ncoIn . J •
MCit te,ZIP c de,and co nt � — j (� Q �/
0 y )t {- 4r r,.. I ��lC`14 . C"? (. - .`-I" -coo
- g6C,—c) .
t Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
Z 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
1 transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
Last 5 of SSN:
Page 3 of 5
CO PY