Homestead_Kemper H. PREPARER
Preparer of the Sales Disclosure Form Title
Kandace Rodgers Closing Agent
Company
Address(number and street,city,state,country,and ZIP Code)
4905 Theater Drive, Evansville, IN 47715
I. SELLERS)/GRANTER(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Brett A. Lemmons
Add{ess umber arr(i jtreet) j Address(number and street)
H.�O( AAii�\II 11 J1VI t} }
i �
city.stat state.-and ZIP Code \ 1--(
r /t- r./ City,state,and ZIP Code
-1 6) An.C} - t, 1 I - L.(�'j U {5 Country
Country
USA
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 roperty,or omits or ny information required to be provided,commits a Level 5 felony.
Sign ure of Seller ,-- �� Signature of Seller
d Name of Seller Dat signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Brett A. Lemmons 07/05/2022 �
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL,Id/APPLY
Buyer 1—Name as it appears on conveyance document f Buyer 2—Name as it appears on convey,�nce `emu eJ
David Kemper I � ✓c'e Q �
Address(number and street) f Address(number and stre4 7 jO� VVV
106 West Williams Street, ! 2
City,state,and ZIP Code City,state,and ZIP Code ��ti O �
Fort Branch, IN 47648 -4
Country O
Country R
USA
NO CONDITION
1.Will this property be the buyer's primary
Cl 0 3. Homestead
O O residence? O O 4.Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated O O 5.Wind Power Device
O O for this residence? If yes,provide address: 0 O 6.Hydroelectric Power Device
Address(number and street) 0 l 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county x ,-t g- 13-t 02 - 0 0 0.4 oC -O 26
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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