HomeMy WebLinkAboutHomestead_SholtisH. PREPARER
Preparer of the Sales Disclosure Form
Title
Christina Lenfers
Settlement A ent
Company
Email Address
Telephone Number
Bosse Title CQmoanv
( 812 ) 421-4000
Address (number and street, city, state, country, and ZIP Code)
4799 Rosebud Lane, Newburgh, IN 47630
I. SELLERS)/GRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as appears on conveyance document
Tab A. Burcham
Elaine L. Burcham
Address (number and street)
Address (number and street)
4119 E. Oak Ridge Est.
4119 E. Oak Ridge Est.
City, State, and ZIP Code
City, State, and ZIP Code
Haubstadt, IN 47639
Haubstadt, IN 47639
Country
Country
u5
us
Email Address
Telephone Number
Email Address
Telephone Number
eazhardy@yahoo.com
( $ o—) &10 3{0 d— I
I
( )
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 an information required to be provided, commits a Level 5 felony.
Nna o Iler
-Wan ure of Selle�c
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Tab A. Burcham
10/19/2026
Elaine L. Burcham
10/19/2026
J. BUYER(S)/GRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS — 12t!lFtAkl. THAT APPLY
Buyer 1 — Name as it appears on conveyance document
Buyer 2 — Name as it appears on v ance c ent
Ha den Sholtis
Autumn Sholtis
Address (number and street)
Address (number and street)()C/.
2918 Lenox Dr.
2918 Lenox Dr.
City, State; and ZIP Code
City, State, and ZI de 26'
Evansville, IN 47725
Evansville, IN 4t
Country
Country
CAN
us
us
Email Address
Telephone Number
Email Address 01);
phone Number
haydensholtis0@gmail.com
( 812 ) 451 6338
autumnsholtis0@gmail.com
r12 ) 483-7369
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
❑ 1. Will this property be the buyer's primary
�fv ❑ 3. Homestead
residence?
❑ ® 4. Solar Energy Heating or Cooling System
❑ ® 5. Wind. Power Device
- 2. Does the buyer have a homestead to be vacated
for this residence? If yes, provide address:
❑ ® 6. Hydroelectric Power Device
❑ ® 7. Geothermal Energy Heating or Cooling Device
Address (number and stet)
L� yLAl. 4 3
City te, and ZIP Co
��� Co my
a
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 6-1.15.5. 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, SSWOriver's LicensedD/Other Number is necessary only if a Homestead Deduction is being filed.)
Si natu� ofZerg?'
Sig ture Buyer 2/Spouse
fLf l(/�
Prin d Legal Name of Buyer 1 Sign Date (MM1DD/YY)
P nted Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Hayden Sholtis 10/19/2026
Autumn Sholtis 10/19/2026
Last 5 Di ' r1 SSN/Driver's License/ID/Other Number
Last 5Qi1 It frer 2/Spouse SSN/Driver's License/ID/Other Number
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