Homestead_Kemper INDIANA SALES DISCLOSURE FORM SDP ID: Page 2
:D.PREPARER . .. - . . , - -
CHRISTINA LATHAM TITLE CLERK
Prepare(of the Sales Disclosure Form Title
4703 THEATER DRIVE REGIONAL LAND TITLE
Address(Number and Street) Company
EVANSVILLE, IN 47715 812-402-4553 CHRISTINA(@REGIONAL-LT.COM
• Cep,State and ZIP Code Telephone Number
E-mail
E.SELLERS)/GRANTOR(S) . ' ' . '. ) . . . - .
Mary Jo Deputy Irrevocable Trust
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
A) 4'a'ti 14/C111P2s-c-IeId POve-
Addr (Number and Street) Address(Number and Street)
k E vans Vc. ke TIV 4170)5
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and com I lete as required by law,and is prepared in accordance with IC 6-1.1-5.S,"Real Property Sales Disclosure Act".
_. • ' I I . Its • s__t It 4 4-_ ' tta
Signss re a Seller 1 l y Signature of Seller
MelissaJ Wagner Trustee X 9//�! i /
Printed Name of Seller Sian Date(MM/DD/YYY11 Printed Name of Seller te(MM/DWITYY)
;F.BUYER(S)%GRANTEE(S)-APPLICATION FORPROPERTYTAXDEDUGTIONS-IDENTIFY AL1>l1�SIIIITA .r "
Anthony D.Kemper ���LLLLLL 11�� 1�II
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance dgampne
,k706— /0U S hrJ 0 2017
Address(Number and Street) Address(Number and Street)
X
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I YES NO CONDITION
❑ 1.Will this property be the buyer's primary f�J ❑ 3.Homestead
residence? Provide complete address of primary ❑ 5 4.Solar Energy Heating/Cooling System
residence,including county: ❑ a
11111E 100S 5.Wind Power Device
Address(Number and Street) ❑ 12 6.Hydroelectric Power Device
Oakland City, IN 47660 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,St Code County
❑ 2.Does the buyer have a homestead in Indiana to be ❑ 0 8. Is this property a residential rental property?
State
vacated for this residence? If yes,provide ❑ 0 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
including county: below. Please see instructions for more information.
Not available in all counties.)
Address(Number and Street) /tI�
fig,.State ZIP Code County a rI3 13-401 -000) —3
3.-13-1
Primary property owner contact name E-mail