Homestead_Lewis (15) 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)IGRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on cony lace document
Burke Rentals, LLC �
Ajosa
ess(number and street) ,� Address(number and street)
.5 . qs E.
City,,gale,and ZIP Code City,state,and ZIP Code
f&I'l 5 1 S A/ ii'll,Lt ei Fes, 40
Country Country I
US US �,a ' 411
CO C >/m ( )
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,7 xect and co as
required b w,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally fa value tr s red
real ro ,or omits or f Isifies an information required be provided,commits a Level 5 felony. Oi9 C
S n f Seller Signature of Seller
r d me of Seller Date signed mm/ddlyyyy) Printed Name of Seller Date signed(m v�y)
aura L. Burke Member 01/25/2024
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
Steven M. Lewis
Address(number and street) Address(number and street)
305 West Strain Street
City,state,and ZIP Code City,state,and ZIP Code
Fort Branch, IN 47648
' Country Country
US US
Q
(812)
rlPursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply:
P4 YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary O 0 3. Homestead
cD O 0 O residence? 0 O 4. Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device
for this residence? If yes,provide address: p 1 6. Hydroelectric Power Device
(A Address Cnum er and street) 0 0 7. Geothermal Energy Heating or Cooling Device
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City,gala,ZIP code_,and county
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c>O Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
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