Homestead_Melton H. PREPARER
Preparer of the Sales Disclosure Form Title
Payge Marx 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 c v n docu t
Patrick Fred JohnsonI)
Address(number and st`eta Address(number and street)
5-1eQ S . 0 S �LI1
City,state,and ZIP Code City,state,and ZIP
OwenSv► 1-e , )N lAll.PlW5 a ���3
Country Country SO� Q
US 4/N�
E-mail address
O/,C)
R
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 property,or omits or falsifies any information r quired to be provided,commits a Level 5 felony.
(„519np of Seller Signature of Seller
:!...0 -3./1-4a!7)(2_
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Patrick Fred Johnson 10/05/2023
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIO ,I NTIFY ALL THAT APPLY
Buyer 1 -Name as it appears on conveyance document Buyer 2-Name as it p e o cony document
Keenan Melton
Address(number and street) Address(number and street)
415 South State Street OCT
City,state,and ZIP Code City,state,and ZIP Code 4 O Z023
Chandler, IN 47610 ,��om
Country Country G/BSON t { �,!/�� M -
US
certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
O 0 1.Will this property be the buyer's primary CIO 3. Homestead
residence? O C1 4.Solar Energy Heating or Cooling System
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) O Q 7. Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
ale-\ - l q -IC[ -OO I 0 I. -C-1
COPY