Homestead_Anderson r H. PREPARER
Preparer of the Sales Disclosure Form Title
Settlement Agent __. _ _______
Company — — ~ E-mail address Telephone number
First Advantage Title Services,LLC 1 ( )
Address(number and street,city.state,country.and ZIP Code)
2301 N.Burkhardt Road,Evansville,IN 47715
I.SELLERS)/GRANTOR(S)
Seller 1—Name as It appears on conveyance document Seller 2—Name as appears on conveyance document
Jennifer Lynne Thacker Kimberly Jan Kohimefer FILED
Address(number and street) Addmss(number and street)
-E1-50S C01E150S
City,state.and ZIP Code City.slate,and ZIP Code B 2 2022
r1;n..et.�n,If l 47070 FEB
Country Country
US US
E-mail address Telephone number E-mail address �IgSOu a°� Quj1 OR( ) t
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 emits or falsifies any information required to be provided,commits a Level 5 felony.
Signature of Seller Signature of Seller
Printed Name of Seller Date signed(nun/dd/yyyy) Printed Name of Seller Date signed(mmtddlyyyy)
Jennifer Lynne Thacker 02/16/2022 Kimberly Jan Kohlmeler 02/16/2022
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR R PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT APPLY
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as it appears an conveyance document
Rian Blake Anderson Caoimhe Brocklebank
Address(number and street) Address(number and street)
45S400F G'IA E k 16S40fF ,.Sn.MG
City,slate.end ZIP Code f r� City.state.and ZIP Code
-Fainic,✓,UT 81629-_. 2f-ttCc +00 A N \'1.l b1 V F'••,,""S LIT`5r5)a
Country Country
US US
apoy for certain deductions.Identify all of those that apply:
YES NO CONDmON YES NO CONDITION
1.Will this property be the buyer's primary (XI 0 3.Homestead
IX! O residence'? 0 ( 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated 0 CX 5.Wind Power Device
0 (X for this residence?If yes,provide address: 0 Oil 6.Hydroelectric Power Device
Address(number and street) �~ T 0 (81 7.Geothermal Energy Heating or Cooling Device
City.state.ZIP code,and county q/_ -\) ^ ,-1-3 OO - 000.5$6 - 0 2R-