Homestead_Bates ' H.PREPARER - !--
Preparer of the Sales Disclosure Form Title f' - _ /
Lana Hamer .... -Sr-'O r.t ______ _ _ —
Company E-mail address Y�) �-u-�4
Address(number and street,city,state,country,and ZIP Code) i
t 5231 Oak Grove Road,Suite A,Evansville,IN 47715 '
I.SELLER(S)GRANTOR(S)
Seller I-Name as It appears on conveyance document Seger 2-Name as appears on conveyance document I
Michael N.Campbell Abigail M.Campbell 1
�Address(number and street) I Address(number and street)
85 E.Center St. 85 E.Center St.
City,state,and ZIP Code i City,state,end ZIP Code
Hemando,MS 38632 i Hernando,MS 38632
Country —
Country
United States of America United States of America
Under penalties of perjury, I hereby certify 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.A person who knowingly and Intentionally falsifies the value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Sign 7se____ 4Signature of Seller
Printed Name of Seller Date signed(mm/ddlyyyy) I Printed Name of Seller I Date signed(mm/ddryyyy)
i Michael N.Campbell I Ot/OS/?.o2 Abigail M.Campbell I
{ J.BUYER(S)IGRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT APPLY
i Buyer 1-Name as it appears on conveyance document Buyer 2-Name as appears on conveyance document
Timothy R.Bates— I Kaylee R.Epperson — -.4
Address(number and street) I Address(number and street)
731 Polk Drive _ i 731 Polk Drive
City,state,and ZIP Code 1 City,state,end ZIP Coda
Oakland City,IN 47660 I Oakland City,IN 47660
Country Country
United States of America United States of America
E-mail address
Pursuant to IC e-1.1.12.444,the Sales Disclosure Form may be used to a�pi-y for certain deductions.identify ail of those that apply: J
YES NO CONDITION YES NO CONDITION G)
0 1.Will this rope be the buyer's rims residence? `,'/ 3.Homestead o
property
y p primary 0 i 4.Solar Energy Heating or Cooling Sys CD ITI
❑ 2.Does the buyer have a homestead to be vacated for CI �L+i f/ 5.Wind Power Device a o I—I
l Y this residence?If yes,provide address: ❑ CI, 6.Hydroelectric Power Device z N r
Address(number and street) 0 [$' 7.Geothermal Energy Heating or Cooling evice
_ C
kJ
City,state,and ZIP Code County
j 26-14-18-203-000.816-007 O
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