HomeMy WebLinkAboutHomestead_RoachI H. PREPARER
Preparer of the Sales Disclosure Form Title
Matthew Jarvis Escrow Officer
Company E-mail address Telephone number
Southwestern Indiana Land Title matt@swinland.com (812) 425-0055
Address (number and street, city, state, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
I. SELLER(S)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as it appears on conveyance document
James C. Burns
James L. Burns, by James C. Burns, his attorney -in -fact
Address (number and street)
Address (number and street)
375 N Helton
375 N Helton
City, State and ZIP Code
City, State and ZIP Code
Springville, IN 47462
Springville, IN 47462
Country
Country
United States of America
United States of America
Email Address
Telephone Number
Email Address
Telephone Number
- 70-62
'912-27B-,6',?yF
- V1 NCsJuly, i iiereuy cermy ims times uisciosure, to the best of my knowledge and belief, is true, correct, and complete as required
bylaw, and is prepared in accordance with IC 6-1.1-5.5. A person who knowingly an intentionally falsifies
the value of transferred real property, or
omits 9 ; falsifies any information required to be provided, commits a Level 5 felony/
Sig `{uure of Se,Uer
Sign re of Seiler
ted Name of Seller Date Signed (mm/dd/yyyy)
�Tinted Name of Seller
Date Signed (mm/dd/
ames C. Burns
yyyy)
times L. Burns, by James C. Burns, is 5/1/2026
5/1 /2026
attorney -in -fact
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
Thomas Roach
Address (number and street)
Address (number and street)
6778 Boston Dr.
City, State and ZIP Code
City, State and ZIP Code
Newburgh, IN 47630
Country
Country
United States of America
-
Email Address
Telephone Number
Email Address
T eph a Number
W-I-W.TV-719r
e_
Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to apply for certain deductions. Identify all of those that
YES NO
CONDITION
1. Will this property be the buyer's primary residence?
2. Does the buyer have a homestead to be vacated for
this residence? If yes, provide address:
Address (number and street)
City, State, and ZIP Code County
Lam!
YES
NO
CONDITION
sa
121
❑
3. Homestead
❑
0
4. Solar Energy Heating or Coolin em
❑
2
5. Wind Power Device r —T-
❑ ❑ 6. Hydroelectric Power Device Pmmm9
❑ RI 7. Geothermal Energy Heating or Cooling Device
,0-m5
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 transferred real
property, or omits or falsifies any information required to be provided, commits a Level 5 felony. (Note; Both spouses information, SSN/Driver's
License/iD/Other Number is n essary if a Homestead Deduction is being riled.)
ignature of Buyer 1
Signature of Buyer 2/Spouse
Printed Legal Name df Buyer 1 Sign Date (MM/DD/YY) I Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
�-IL / -
Thomas Roach ) RI `�
11
Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number I Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
SSN: 6> `7q 7D VIV D1-: 96 31
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