Homestead_Catt� INDU\ASALESDISCLOSUREFOR\I SDFtD SDOID N72654 pag�Z
D.�PREPARER� . . �.:: . ..� � .-_ j �.:-�: . . . ��, . - _--
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Kimbedy A. Lewis Office Manager
PrtparerofNeSolesDisdosureForm Tflle ,� '
26 W. Broadvra Broadway rile, Inc.
Addren (NvmDvoiMSttee�J Campony
Princeton, IN 47670-
E.SECLER S GILINTOR S . ='-;�, +'- ; ".' � ,.;-. ;_` ' " �
John R. Kem Lisa A. Kem
Sellrr I- Nume os uppvrs un oortveynnce dumment Seller 2- Name as a➢peun on mrtrry�once docvmen[
109 S. Vonna Lane 709 S. Vonna Lane
Address (Nun. berarW SReetJ Addrcu (Nuniber andS[reet)
Haubstadt, IN 47639- Haubstadt, IN 47639-
Ciry,Smte,andLPCade Ciry,Smte.andLPLode � n
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Under penalties of perjury, 1 hereby certlfy tha[ this Sales Disclosure, [o [he bes[ of my knowledge and belief, is true, correc[
and conip te� required by law, and is prepared in accordance wi[h IC 6 1-5`5, "fteal Pr�er[y Sales Disclosure Act".
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'EBUYER S GRANTEE S s-APP,GICATiON EORPROPERTYTAXDEDUCTIONS-:IDENTIFYACGiTEMS.THATAPPLYr �= -
Taylor J. Catt Niwle ,� Catt
Bvyer 1� Name as appevrs an rnnve�vnce dacvmen[ 8vyer7 � Namc vs aypeorsam m�veyartce dwument
701 E. SinGair 707 E. SinGair
AdEress(NumberandSUertf Addrcss(,Yvm6erandShreQ
Fort B2nch, IN 47648- Fort Branch, IN 47648-
Ciry, Smte, and ZIPCode Ciry, Smte. and Z/➢ Code
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THE SALES DIS[LOSURE FORM AIA4' BE USED TO APPLY FOP CERTAIN DEDURIO.VS FOR THIS PROPERTV. IDEhTIFY ALL OF THOSE Tl1AT APPLY.
YFS NO COSDITION 1'FS NO CONDTON
x� � 1. Will this property be the buyer's primary ❑x ❑ 3. Homestead
residence? Provide complete address of primary � � 4. Solar Energy Heating/Cooling System
residence, including county: ❑ �
109 S VONNA LANE S. Wind Power Device
Address(,YVm6ualM5tml) ❑ Q 6. Hydroelectric Power Device
Haubstadt, IN 47639 GIBSON � � 7. Geothermal Energy Heatlng/Cooling Device
[iry, Sm¢ ZlPCOCt Caunry
❑x ❑ 2. Does [he buyer have a homestead in Indiana to be � � 8. Is this property a residen[ial renial property?
vacated For this residence? If yes, provide ❑ Q 9. lNould you like [o receive [ax s[atements for this
comple[e address of residence being vacated, property via e-mail? (Provide ron[oct information
including county: 6elow. Please see instrucpons jor more information.
707 E. SINCWR No! avuiluble in all munties.)
Address(NumberoMSO2eQ
Fort Branch, IN 47648 GIBSON z 6_i k,-3 �y o u 3- odo a5 6-c�
Ciry.SmteZfPCade Covnry
Pnmaryproperryou�nermn:acrnvme E�mail
Under penalties of perjury, 1 hereby certify tha[ [his Sales Disclosure, [o [he best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance wi[h IC 6d.1-5.5, "Real Property Sales Disclosure Ac[". (Note:
Spouse information, Social Security and Driver's License/Other numbers are no[ necessary if no Homestead Deduc[ion is
being filed.) a �+ �
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