Homestead_McKimmy[J
INUTANA SALtS DISGLOSURE FORM SDF ID: 2012 ' Page 2
D. P PARER -
~�"6�,/ GS ev�lyt - e
P�eparerol the Sales Disclosore Fonn Title
605 SE Martin Luiher King Jr Boulevard Southwestern Indiana Land Title
Address (NUmbe� antl St�eetJ
E-mail
E. SELLER(S) I GRANTOR(S)
�( ev'1 P�. (�'�r�C�,C�II
Seller 7- Name as appeaa on conveyance document Seller 2- Name as appears on conveyance tlocument
i�� �,�tc e�+- ,� o� E�;� �
Address (NUmber and S�eef) Address (Num6er and StreeQ
� O/���1c� �Jtl , I N �-1� S cs� �
Ciry, State, and ZIP Code Ciry, S(ate, antl Z!P Code
�
Telephone Num6e� E-mail
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, "Real Property Sales Disclosure AcY'.
`�Y �: �. 1�1ac�ld�'�
Signature o/ Selle� Signature o( Seller
K�ri� 8. i1�lc�.old�u lD= zy-t2
Pnnted Name of Seller ign Date (MM/OD/YYYY) Pnn(etl Name o; Seller Sign Dafe (MM/DDNYYY)
F. BUYER(S)IGRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL ITEMS THAT APPLY
Brian A. McKimm
Buyer i- Name as ap0ears o r ya „umy�t �� Buyer 2- Mame as appears on conveyance document
i�i�,�� r-t i�
A�dress (Numbei and Street) Address (Numbei and S;reet)
. �N �( F�o3 � �✓ ��� iL
Ciry, Stafe, and Z,I/P Code � � �/� 7 Ci;y, State, and ZIP Code
(
Telephone Numbe� E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION � YES NO CONDITION
❑ 1. Will this property be ihe buyer's primary '�,$� ❑ 3. Homesiead
residence? Provide complete address of primary p � q. Solar Energy Heating/Cooling System
residence, including county:
❑ GY 5. Wind Power Device
803 E Walnut St.
.4ddress (Numberand Srreeq ❑ d 6. Hydroelectric Power Device
��;Fort Branch, IN 47648 ( Gibson � d�� Geothermal Energy Heating/Cooling Device
Ciry, Srare z�P Code County ❑ (y 8. Is this property a resideNial rental property?
� �2. Does the buyer have a homestead in Indiana to be � � 9. Would you like to receive tax statements for this
vacated for ihis residence? If yes, provide complete property via-email? (Provide contact inlormation
address of residence being vacated, including county: below. Please see instructions formore in(ortr�ation.
Nol available in all counfies.)
Address (Numbe� and Street)
��-/9-/8• 3oy-oao,��l3-0�_
Ciry, Sfate ZIP Code County Pnmary property mvner contacf name E-mail
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 I w, and is prepared in accordance wi[h IC 6-1.1-5.5, "Real Property Sales Disclosure AcY'. (Note: Spouse
informationy� ocial Sec ity Drive 's Lic selOther numbers are not necessary if no Homestead Deduc[ion is being filed.)
1 /�-'� >,' e'ni1 �� / / ` �
�gnature oPBuyer 7� � yyy��� Signature oFBUyer 2/Spouse
Brian A. McKimmy /���
Pnn( Le9a1 Name o�
Lasf 5 digits olBoyer 7 Onve/s Stafe Last 5 Digits oF Social Secunty Numbe� Lasf 5 digifs ot Buye� 2 Omers State Last 5 Digi(s of SoGal Secunry Numbeo/
License/ID/Othe� Number License/ID/Other Num6er ��
