HomeMy WebLinkAboutHomestead_BuryH. PREPARER
rreparer of the Sales Disclosure Form
Title
Matthew Jarvis
Escrow Officer
Company
Southwestern Indiana Land Title
E-mail address Telephone number
Address (number and street, city, state, country, and ZIP code)
matt@swinland.com (812) 425-0055
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
I. SELLER(S)1GRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as it appears on conv c ocument
Lisa Faye Godwin
k;
Address (number and street)
Address (number and s
514 N First St
City, State and ZIP Code
Owensville, IN 47665
City, State and ZIP Cod •�Q'L
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Country
United States of America
Country
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Email Address le hone Number
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Email Address ephone Number
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Under penalties of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge and belief, is ue, correct, and complete as required
by law, and is prepared in accor ce with IC 6-1.1-5.5. A person who knowingly and intentionally falsifies
the value of transferred real property, or
omits or f Iifies y informati n r quired to be provided, commits a Level 5 felony.
gna pf Sell
Signature of Seller
P ' to Name o Seller Date Signed (mm/dd/
Lisa Faye Godwin yyyy)
Printed Name of Seller Date Signed (mm/dd/yyyy)
9/2/2026
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
Ethan E. Bury
Kayla J. Courtney
Address (number and street)
Address (number and street)
5225 S 450 W
5225 S 450 W
City, State and ZIP Code
City, State and ZIP Code
Owensville, IN 47665
Owensville, IN 47665
Country
Country
United States of America
United States of America
Email Address
ele
whone Number
Email Address
ele7phone Number
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 apply:
YES NO CONDITION
YES NO CONDITION
0 ❑ 1. Will this property be the buyer's primary residence?
0 ❑ 3. Homestead
❑ 0 4. Solar Energy Heating or Cooling System
El2. Does the buyer have a homestead to be vacated for
this residence? If yes, provide address:
❑ 0 5. Wind Power Device
❑ 0 6. Hydroelectric Power Device
Address (number and street)
❑ Z 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County
t
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 spouse's information, SSN/Driver's
License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
Signature oaf Buye,51
igngture of Buyer 2/Spouse
7
Printed Legal Name of 8;yer 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Ethan E. Bury 9/2/2026
Kayla J. Courtney 9/2/2026
orast 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number
SSN: 7-03
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
.�3 2. v c ° .96 y
SSN: LID7
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