Homestead_Kepple H. PREPARER
Preparer of the Sales Disclosure Form Title
Christa D.Tracey Escrow Officer
Company
Address(number and street, city, state, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
I. SELLER(S)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as it appears on conveyance document
The Estate of Evangula A. Bradshaw
Address(number and street) Address(number and street)
741 E 750 S
City, State and ZIP Code City, State and ZIP Code
Fort Branch, IN 47648
Country Country
United States of America
E-mail address 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.
Si ure of Seller�� Signature of Seller
cad Na e o �/ Date signed(mm/dd/
Pri t Name of Seller/ J Date si ned(mm/dd/yyyy) Printed Name of Seller 9 YYYY)
`� j�7 /�PQ f^ 3/8/2022 3/8/2022
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THA IP
Buyer 1 -Name as it appears on conveyance document Buyer 2-Name as it appears on o �`vf/eI .
r do et^
Micah J. Kepple Amy E. Kepple L./ / ]
Address(number and street) Address(number and street) MqR
3467 Franklin St. Rd. 3467 Franklin St. Rd. 1 .S
20
City,State and ZIP Code City, State and ZIP Code fi 21 -�
,,
Auburn, NY 13021 Auburn, NY 13021 G/BSOH p / (("V
Country Country AUNTY�G'
United States of America United States of America AUD/
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 YES NO CONDITION
V ❑ 1. Will this property be the buyer's primary residence? W-' 0 3. Homestead
El �4. Solar Energy Heating or Cooling System
❑ �2. Does the buyer have a homestead to be vacated for ❑ g/ 5. Wind Power Device
this residence? If yes, provide address: 0 a-"66. Hydroelectric Power Device
Address(number and street) ❑ 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code,and county
, ,t,Q-14 -' .o-1 QO-(Do'-.vA 13_Q--&.S