Homestead_Johnson 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) 1 r ~')?-
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on cpk,eItnce c}�cament
Justin A. Lamey ' �
Address(numbers d street) Address(number and street)f+C
S51(v A! M�' �
1 � • ,77Cip"6
City,stp and ZIP Code City,state,and ZIQode 702a
Country Country ''' '�-,
US US ?,
E-mail addres address .,j,lephone number
Under penalties f pe ry,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete as
required by la ,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 formation required to be provided,commits a Level 5 felony.
Si i,re of S r Signature of Seller
rint Name of Seller Date signed(mm/ddlyyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Justin A. Lamey 09/14/2023
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
Daniel J. Johnson Louis E. Polach
Address(number and street) Address(number a distreet)
1234 Negley Avenue I./3 y i 1 `, A vt-(_
City,state,and ZIP Code City, ,and ZIP Code /'TA/
�)Evansville, IN 47711 V�� e-vI� 1 M
Country Country
US US
YES NO CONDITION YES NO CONDITION
O O 1.Will this property be the buyer's primary O 0 3. Homestead
residence? O O 4. Solar Energy Heating or Cooling System
cj
O 2. Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device
for this residence? If yes, provide address: 0 O 6. Hydroelectric Power Device
Address(number and street) 0 O 7. Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
. 6--.VI- -(2-1,02-- 0 o 0 3 bc1-02Z
)
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