Homestead_Hensley (2) H. PREPARER
Preparer of the Sates Discos a Form /\ j
�� �.�/'�/(J Title It e (per4 ( ' -
Company
Address(number and street,city,state,country,and ZIP Coda)
7820 Eagle Crest Blvd,Suite 201,Evansville,IN 47715
I. SEL. _. __)/GRANTOR(S) .-_.___.r.
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Kevin J.Blemker Jerri A.Blemker
Address(number and street) Address(number and street)
905 N Main Street 905 N Main Street
City,state,and ZIP Code City,state,and ZIP Code
Oakland City,IN 47660 Oakland City,IN 47660
Country Country
US US
Under penalties of perjury,I .ereby certify this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete as
required b 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 . •pe y,or omits or falslfle, any information required to be provided,commits a Level 5 felony.
S gna ure . •etle- / Si,nature of Seller
rl. +-d Name <a ter Date signed(mm/ddlyyyy) Pri l.. Name of Salter Date signed(mmlddlyyyy)
evin J.Blemker 12/09/2021 Jerrl A.Blemker 12/09/2021
`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
Zakeriah D.Hensley
Address number and trees) Address(number and street)
2-2-7 ��d E.
City,state,and ZIP Code City,state,and ZIP Code
Countryin' ,k/G`PG1 6114 -VI. _ L(7466 _
Country
Us
for certain deductions.identRyalf of those that sag
YES NO CONDITION 1 VAS NO CONDITION o-
14 , 1.Will this property be the buyer's primary p 3.Homestead o
z D zi
residence? 0 4.Solar Energy Heating or Cooling Sy� ' 1
2.Does the buyer have a homestead to be vacated 5.Wind Power Device cz Q •-'I
for this residence? if yes,provide address: 0 6.Hydroelectric Power Device ➢r gN N -
Address(number and street) 0 I0 7.Geothermal Energy Heating or Cool ce
o -
City,state,and ZIP Code County C)
26-14-18-201-000.105-007 W