Homestead_Birdwell H. PREPARER
Preparer of the Sales Disclosure Form Title
Jamie E. Smith Escrow Officer
Company
Address(number and street, city,state, country, and ZIP Code)
101 Plaza East Boulevard, Suite 102, Evansville, IN 47715
I. SELLERS)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
SCOTT ALAN CLARK KATHRYN CLARK
Address(number and street) Address(number and street)
9596 W 575 South 9596 W 575 South
City,State,and ZIP Code City,State,and ZIP Code
Owensville, IN 47665-8947 Owensville, IN 47665-8947
Country Country
E-mail Address
Under penalties of perjury,I hereby certify 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 transferred
real pro erty,or omits or falsifies any info tion required to be provided,commits a Level 5 felony.
ignatu of S / I Signatur- of Seller I-t —2 5—^2 3
t (,+r �(-�-, 7 5:A. • 40tLl 0 Sim l
Punted Name of Seller Date Signed (mm/dd/yyyy) Pnnted Name of Seller Date Signed(mm/dd/yyyy)
SCOTT ALAN CLARK July 25, 2023 KATHRYN CLARK July 25, 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
OLIVIA BIRDWELL
Address(number and street) Address(number and street
9596 W 575 South
City,State,and ZIP Code City,State,and ZIP Code
Owensville, IN 47665-8947 Jam/� la
Country Country UG
q `�2 \
apply for certain d4tt..s(lentify ll of those that apply:
YES NO CONDITION I YES NO CONDIT +'• �
❑ 1.Will this property be the buyer's primary (2 ❑ 3. Homestead gUp/T�¢)
(tL. residence? O
i ❑ �' 4.Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated ❑ [ 5.Wind Power Device
❑ for this residence? If yes, provide address: ❑ a 6. Hydroelectric Power Device
Address(number and street) ❑ j 7.Geothermal Energy Heating or Cooling Device
City,State,ZIP code,and County -) /- —1- n pj _' --o 0 _ oQ A _Gin-- b 2 1
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
transferred real property,or omits or falsifies any Information required to be provided,commits a Level 5 felony.(Note:Both spouse's
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