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Homestead_Burgess (2)
H. PREPARER Preparer of the Sales Disclosure Form Title Katie Felty 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 conveyance document William C. Burgess Barbara A. Burgess Address(number and street) Address(number and street) 411 0 S OLI 41 (00-o Liv ,. Li II 0 Sta.� (coo/ 1.../. City,state,' and ZIP Code . City,state,and ZIP Code v WY"V► N (L.t ✓ U�t C� ©la,�,,y '.114 JA/ `- u7 0 Country Country US US 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 Oroperty,or omits or falsifies any information required to be provide ,commits a Level 5 felony. rure of Seller S n ur of Seller d Name of Seller Date signed(mm/dd/yyyy) 'nted Name of Seller Date signed(mm/dd/yyyy) William C. Burgess 4/9/25 Barbara A. Burgess 4/9/25 J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY Bu e — it appears on conveyance document Buyer 2—Name as it appears on conveyance document acKenzie Burgess Evan Seay ss—A (number and street) Address(number and street) 4 it o S • (r(v Li, WO S. (000 („) City,state,and ZIP Code City,state,and ZIP Code 0 ,�hiAtt rev u7COGs OW'eh i I1�-l� ..4.' Country Country US US E-mail address A YES NO CONDITION YES . COND ON • 12� ' 1.Will this property be the buyer's primary D O 3. Homestea [•G O O residence? SON COUNTY AUDITOR O O 4.Solar Energy Heating or Cooling System O Ly' -. Does the buyer have a homestead to be vacated El 5.Wind Power Device for this residence?If yes,provide address: O [] 6.Hydroelectric Power Device Address(number and street) O O 7.Geothermal Energy Heating or Cooling Device City,state,ZIP code,and county 49?6 r / i -3/ ' ti0o- 06gs, t1.o.z1 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 Page 3of5 '`' ' q k� y.