Homestead_Whitten (3) 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 onikankt t
SCOTT E. BLACKBURN
Address(number and street) Address(number and stre��F) 0
603 E Sinclair Street / l
City,State,and ZIP Code City,State,and Code / �O?Dy I
Fort Branch, IN 47648-9797 G/ems ,l \ \j
Country Country N COS
Au
E-mail Address
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.
nature of Sell r Signature of Seller
Print Name of Sel er I Date Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
SCOTT E BLACKBURN August 11, 2023 August 11, 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
AMANDA WHITTEN ANDREW WHITTEN
Address(number and street) Address(number and street)
603 E Sinclair Street 603 E Sinclair Street
City,State,and ZIP Code City,State,and ZIP Code
Fort Branch, IN 47648-9797 Fort Branch, IN 47648-9797
Country Country
YES NO CONDITION YEO �OONDITION
27-7-11.Will this property be the buyer's primary [�/ 3. Homestead
L_I residence? ❑ 0/•4.Solar Energy Heating or Cooling System
. Does the buyer have a homestead to be vacated El �5.Wind Power Device
Li for this residence? If yes, provide address: ❑ . Hydroelectric Power Device
Address(number and street) ❑ LJ 7. Geothermal Energy Heating or Cooling Device
City,State,ZIP code,and County
(6-k`t — 1 -301 - ouo , 6 ? A -oL
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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