Homestead_Bechtold H. PREPARER
Propane'of the Sales Disclosure Form ' Title
Gwyn Shaw
Company
Address(number and street,city,state,country,and ZIP Code) -
5231 Oak Grove Road,Suite A,Evansville,IN 47715
I. SELLERS)/GRANTOR(.S)
Seller 1-Name as it appears on conveyance document - Seller 2-Name as appears
on conveyance document
James P.Pegram Kelly L.Pegram
11 Address(number and street) ->>r .
Y (12'7,S m Y P LR..vseS L>ry3 T Address(number and street) �01,-i,E
City, ,and ZIP Code ` \
Vet S G Y U IL--al "-C - 44.)<6 3 3 City,state,and ZIP Code
County Country
United States of America United States of America
required by law,,and Is prepared In accordance with IC 6-1,1-55.5.A person who knowingly and intentionally falsifies the value of transferred
real property,or omits or falsifies any Information required,to bg_ptovided,commits a lev4ic5 felor;y.-
316natu e of Sene n nature of Septet._ z{
"..---if71? ...../1 .1._
Printed Named Seller Data (tMtt/dd/yyyy) Printed Named Seller s t S rrnh M
James P_Pegram +� . Kelly L.P ram I t- `T7/^
J.BUYER(S)IGRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT APPLY
,
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as appears on cony ce ent■�--i�
David M.Bechtold Connie J.Bechtold 1 J 11 I ,
Address(number and street) Address(number and street)
6398 W.Stalheim Ave 6398 W.Stalheim Ave APR 1 3 2022
City,state,and ZIP Code City,state,and ZIP Code
Owensville,IN 47665 Owensville,IN 47665 a a L
Country
YES NO CONDITION YES NO CONDITION
0 3. Homestead
0 1.Will this property be the buyer's primary residence? 0 0 4.Solar Energy Heating or Cooling System
Ar+/ ❑ 2.Does the buyer have a homestead to be vacated for 0 05.Wind Power Device
� this residence? If yes, provide address: 0 0 6. Hydroelectric Power Device
Address(number M e�� An-'-
City. q❑ 0 7.Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code ) 6 '- 1 1 ^ 3 1 -3 0 0 ^�o k_1 . 6 l b - 0 2 1 .
t!',0 v/Ai 4 -Ta-r,} .. Ai 47 73 2 w w riJl?C r-4 OC
Under penalties of perjury, I hereby.certify that this Sales Disclosure,to the best-of ray and belief,is true,correct and complete
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