Homestead_Kohl (2) { H. PREPARER
Preparer of the Sales Disclosure Form 1 Title
Arnie Maslanka Settlement Agent
Company E-mail address
Address(number and street,city.stale.couiiry.and ZIP Code)
4799 Rosebud Lane,Newburgh, IN 47630 ,+ _ _
II. SELLER(S}IGRANTOR(S) er_-._JQtT La?ti. LI6)-ia..Lia&- � '
Seller 1-Name as it appears on conveyance document Seiler 2-Name as appears cc
nee ocumen. % tug
John Mark Hagedorn and Clara Mae Hagedom Irrevocable Trust dated 1 1 D-4?k, oh1`t ra.
Address(number and street) r �� �. Address(number and street) /
6975 S. 175 E. I �1 ` CU 5 I -'
j City.state.and ZIP Code Ir�Cr "C City.state.and ZIP Code� �� �( F�
Fort Branch, IN 47648 �b{/j N4 rI t
Country Country
US [/(
` '
1
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 6-1.1-55.A person who knowingly and intentionally falsifies the value of transferred
real property,or omits or falsifies an rmation required to be provided.commits a Level 5 felony. ;
IS. .ature of Seller Signature of Seller/2 , /' -' '
I Printed me of Seiler _ I Date signed(mrt/dd/yyyy) Printed Nlf\m)a of Seller� � �p Date signed(mm/ddfyyyy)
tr+sS l 03/30/2022 C 0ki..90" �.—�,`1�-"`"�— 03/30/2022
J. BUYEOS)JGRANTEE(S)-APPLICATION FOR PROPER TAX DEQUCTiONS-IQENTI AT
Buyer t-Name as it appears on conveyance res'rnent Buyer 2-Name as it appears on
Evan D. Kohl Taylor M. Kohl
Address(number and street) Address(number and street) APR 0 4 2022
6975 S.175 E. 6975 S. 175 E.
City_state.and ZIP Code City.state,and ZIP Code '/ur_i1 a. L1(a-t'QtT4�
Fort Branch.IN 47648 Fort Branch, IN 47648 GIBBON COUNTY AUDITOR
Country Country
US US
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 Y NO GONDITIOh[
Q 3.Homestead
1_Will this property be the buyer's primary
} C residence? p fx 4.Solar Energy Heating or Ceoiing System
2 Does the buyer have a homestead to be vacated 0 .�`� 5_Wind Power Device
u for this residence? If yes,provide address: 0 ,�. 6_Hydroelectric Power Device
Address(rum and street) 0 (Q 7_Geothermal Energy Heating or Cooling Device
City.state.ZIP code.and county ✓� O 0 32q Z s�
a� ')q -kh
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
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