Homestead_Holzmeyer •
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER ,
Britany N Barnes Agent
Preparer of the Sales Disclosure Form Title
226 W Broadway Broadway Title, Inc
Address(Number and Street)
E.SELLER(S)/GRANTOR(S) . •
Joshua A. Kohlmeyer Shannon R. Kohlmeyer
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
914 Mohawk Dr 914 Mohawk Dr
Address(Number and Street) Address(Number and Street)
Fort Branch, IN 47648 Fort Branch, IN 47648
E-mail
Under s enalties of perju ,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
a. . coin-lete s re • y law,and is prepared in accordance9� h IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
nature of Seller Signature of Seller
Joshua A. Kohlmeyer Shannon R. Kohlmeyer
Printed Name of Seller Sign Date(MM/DD/m7) Printed Name of Seller Sign Date(MM/DD/YYYY)
'F.BI ER{--S /-& AN.T&E(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITE A1-.APP ty; 1
Chad K.Holzmeyer ' _IL.,,i _J
:uyer - . .,,ears on conveyance document Buyer 2-Name as appears on conveyance document
2918 Courtz Court DEC 0 6 2019
Address(Number and Street) Address(Number and Street)
Newburgh, IN 47630
E-mail Telephone Number 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 9ND N
❑✓ ❑ 1.Will this property be the buyer's primary . ❑✓ ❑ 1 Homestea
residence? Provide complete address of primary ❑ ❑✓ 4.Solar Energy Heating/Cooling System
residence,including county:
914 Mohawk Dr ❑ ❑✓ 5.Wind Power Device
Address(Number and Street) ❑ ❑✓ 6.Hydroelectric Power Device
Fort Branch, IN 47648 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
ity,State ZIP Code County
1(:, III 2.Does the buyer have a homestead in Indiana to be
❑ ❑✓ 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ ❑✓ 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
q i C
including county: �� below.Please see instructions for more information.
j Not available in all counties.)
ddress`(Number and Street)
City,State ZIP Coi ( ' County
Primary property owner contact name E-mail
Number License/1D/Other Number