Homestead_Nurrenbern H. PREPARER
Preparer of the Sales Disclosure Form Title
Amy B.Pollard ' Settlement A.ent
Company
Address(number and street,city,state,country,and ZIP Code)
7820 Eagle Crest Blvd,Suite 201,Evansville,IN 47715
I. SELLER(S)/GRANTOR(S) Willa
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Dillion J.Clark Marissa H. Clark SE• i -
Address(number and street) Address(number and street)
6136 W Stalheim Ave 6136 W Stalheim Ave ,
City,State,and ZIP Code City,State,and ZIP Code
Owensville, IN 47665 Owensville, IN 47665 GigSON,CO
Country Country 'eDITOR
1 US US
Email Addresst (
best of myknowled a and belief,is true,correct,and complete as
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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 pr perty,o or falsifies any information required to be provided,commits a Level 5 felony.
Sig to friiiture of Seller
��++
/Pri am of eller Date led(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
lion J.Clark 08/ /2023 Marissa H.Clark 08/ 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
Joshua Nurrenbem Melissa Nurrenbern
Address(number and street) Address(number and street)
312E780S 312E780S
City,State,and ZIP Code City,State,and ZIP Code
Fort Branch, IN 47648 Fort Branch, IN 47648
Country Country
US US
1t Email Address
YES NO CONDITION YES NO CONDITION
® ni 1.Will this property be the buyer's primary l O 3. Homestead
Q residence? 0 (X 4. Solar Energy Heating or Cooling System
I
_7 (X___ 0 2. Does the buyer have a homestead to be vacated 0 ® 5. Wind Power Device
for this residence? If yes, provide address: 0 ® 6. Hydroelectric Power Device
A jiel(nrber_gin estr t) (3 ® 7. Geothermal Energy Heating or Cooling Device
C--
City State,and ZIP Code County
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
C 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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