Homestead_North INDIANA SALES DISCLOSURE FORM SDF ID: 2015 Page 2
D. PREPARER
Teresa S. Holifield Escrow Officer
Preparer of the Sales Disclosure Form Title
605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
Address(Number and Street) Company
Evansville, Indiana 47713 (812)425-0055 teresa @swinland.com
City, State.and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Chris Ronald Klem Tammy Klem
Seller 1 -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
6792 W Stonebead Dr __6792 W Stonebead Dr
Address(Number and Street) Address(Number and Street)
Owensville, IN 47665 Owensville, IN 47665
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true, correct
an co plete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
,
, -. IZ n. ,Q}1 / -,..„--- %7n�11�//.�-�
tgnature of Seller Sig i of Seller/ /
Chris Ronald Klem 7/20/2015 Tammy Klem '� 7/20/2015
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MMIDD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS -IDENTIFY ALL ITEMS THAT APPLY
Kristopher North Jennifer North
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
401 N 1st St 401 N 1st St
Address(Number and Street) Address(Number and Street) ��
Owensville, IN 47665 Owensville, IN 47665 ,, �L
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
0 ❑ 1. Will this property be the buyer's primary 0 ❑ 3. Homestead C�WWTT upITOR
residence? Provide complete address of primary ❑ 0 4. Solar EtWQ�nacrL:obling System
residence, including county:
❑ 0 5. Wind Power Device
6792 West Stonebead Drive
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Owensville, IN 47665 Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
ity. State ZIP Code County ❑ 0 8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be ❑ 0 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete property via-email? (Provide contact information
address of residence being vacated, including county: below. Please see instructions for more information.
cif)] w ( S r Q 1 .. .- Not available in all counties.)
\ ddress(Number and Street) !-T
CI(,J2i((C —f-tJ `I)GG-C (car h5-1,).. 2L)-17-6/ -S/on lcei cJ 8" 5 d a /
City. State ZIP Code County Primary property owner contact name E-mail