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Homestead_Chapman
H. PREPARER Preparer of the Sales Disclosure Form Title Libby Hinshaw Escrow Assistant Company Address(number and street,city,state,country,and ZIP Code) 520 Main Street, Suite 1, Jasper, Indiana 47546 I.SELLERS)/GRANTOR(S) Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document Donald E. Whitehead Family Trust dated Sept 8,2015 Address(number and street) Address(number and street) -� t '-I!"3 IA) Cou;-y `NC- ' ,.. 1)' S City, te,and ZIP Code r City,state,and ZIP Code C Qa'(e-S U: L t N��- 10 t-f (e I a 1 Country Country '* ( ) 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. Signature of Seller Ct42 J`N `�i :- Signature of Seller Printed Name labSeller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy) Dayna R. Stein, Co-Trustee 1/27/2021 Ala A. Lady L4,4 1/27/2021 t J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY Buyer 1-Name as it appears on conveyance document Buyer 2-Name as it appears on conveyance document Jesse A. Chapman Address(number and street) Address(number and street) 11567 E 150 South City,state,and ZIP Code City,state,and ZIP Code Oakland City, Indiana 47660 Country Country E-mail address ( ) Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply: r�---- YES NO CONDITION YES NO CONDITION W a 1.Will this property be the buyer's primary 2 0 3.Homestead z residence? 0 © 4.Solar Energy Heating or Cooling System8 o H /2.Does the buyer have a homestead to be vacated 0 © 6.Wind Power Device z N ri 0 for this residence?If yes,provide address: 0 © 6.Hydroelectric Power Device y N3 VI c d Address(number and street) 0 0 7.Geothermal Energy Heating or Cooling .City,state,and ZIP Code County Xi 26-14-19-200-000.798-006 0 W