Homestead_Anderson (9) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER --
Roman Ricker Attorney
Preparer of the Sales Disclosure Form Title
219 N Hart Street Partenheimer, Kinkle& Ricker
Address(Number and Street)
E-mail
,E.SELLER(S)/GRANTOR(S) i
Fstate of Dustin L.Klem
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
6800 W.450 S
Address(Number and Street) Address(Number and Street)
Owensville, IN 47665
City,State,and ZIP Code City,State,and ZIP Code
Telephone Number 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 comp ete as require by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature o Seller Signature of Seller
Keith L. Klem, Unsupervised Personal Rep 2.19.2020 i
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller ��)I n L.to( /DD/YYYY)
F.jiUY )/QR ER(SANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL ITEMLTHAT "t_"
f
Cameron S.Anderson w Kelly J.Anderson
eyance document Buyer 2-Name as appears on conveyance docum4n(JB 2 0 2020
704 N 275 W 704 N 275 W
Address(Number and Street) Address(Number and Street)
Princeton, Indiana 47670 Princeton, Indiana 47670
Telephone Number 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 YE ON
0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestea
residence? Provide complete address of primary J 4.Solar Energy Heating/Cooling System
residence,including county:
6800 W.450 S. ❑ ❑✓ 5.Wind Power Device
Address(Number and Street) ❑ Z 6.Hydroelectric Power Device
Owensville, IN 47665 Gibson ❑ yi 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ 2.Does the buyer have a homestead in Indiana to be ❑ 0 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
including county: below.Please see instructions for more information.
Not available in all counties.)
Address(Number and Street)
City,State ZIP Code County A 6 - /(1 ..3‘, `'toO - o o Co . l 8 8 _ O oL/
Primary property owner contact name E-mail