Homestead_Bolin H. PREPARER
Preparer of the Sales Disclosure Form Title
Christina Latham Title Clerk
Company
Address(number and street,city,state,country,and ZIP Code)
4600 Washington Ave,Suit 102 Evansville, IN 47714
I. SELLER(S)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Kameron Todd Ashabranner
Address(number and street) Address(number and street)
City,state,and ZIP Code City,state,and ZIP Code
Country ., \\16,\,.
Country
E-mail address Telephone number E-mail address Telephone number
( ) ( )
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 Signature of Seller
Printed Name of Seller Date Printed Name of Seiler Date signed(mm/dd/yyyy)
Karneron Todd Ashabranner
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
Margaret Bolin ILED
AddMaresss(number
er and street) Address(number and strey
Cp ao '' o ckt_ S--tc e e-k
City,state,and ZIP Code City,state,and ZIP Code 52022
0°•1C-lcu C.k rtck , `=tv Li-1(4>Cnc) FEB 1
Country Country
ua� (2. "�1�UD1[OR
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:
YES NO CONDITION �`E�. NO CONDITION
Wil
l ll this property be the buyers primary 0 3. Homestead
„....1‹ 0 residence? O x 4. Solar Energy Heating or Cooling System
O 2. Does the buyer have a homestead to be vacated 0 x 5.Wind Power Device
for this residence? If yes, provide address: O x 6, Hydroelectric Power Device
Address(number and street) 0 x 7.Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County
DC-1u— 18-303 ^ 000.31 --0o4-
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number