Homestead_Campbell H. PREPARER
Preparer of the Sales Disclosure Form Title
Micah Scott Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
7412 Eagle Crest Blvd. Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Kyle N. Bieker Alyssa L. Bieker
Address(number and street) Address(number and street)
NCO' 1M ���1 e���L� CA-.
o��c� C-l . ��
City,state,and ZIP Code City,state,and ZIP Code
/-I-✓bs)QJJ / ,-/V, L/763�t k-Lti,wbs4 c�4 ) � )J �� 1&
Country Country
(�S� 0S :h-
E-mail address
Under penalties of perjury,I hereby cart 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.
ature ller /J _ Onat a of Seller
Printed Nam f Seller Date signed(mm/dd/yyyy) Printed Name o Seller I Date signed(mm/dd/yyyy)
Kyle N. Bieker 07/01/2022 Alyssa L. Bieker 07/01/2022
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as it appears on cony n d um F Y ,,D
Krystal D. Campbell Eric S.Campbell
Address(number and street) Address(number and street) J U L 0 8 2022
12226 South Brooke Drive 12226 South Brooke Drive
City,state,and ZIP Code City,state,and ZIP Code• .,[ ___
Haubstadt Indiana 47639 Haubstadt Indiana 47639 lta o ,J .z''�•`a'
-S Country Country GIBBON UDITOR
N US US
E-mail address
LP 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:
O• YES NO CONDITION YES NO CONDITION
�) Cl 0 3. Homestead
O 1.Will this property be the buyer's primary
O O residence? 0 (D 4.Solar Energy Heating or Cooling System
C) , 2. Does the buyer have a homestead to be vacated
0 O 5.Wind Power Device
0 t 0 for this residence?If yes,provide address: 0 l 6.Hydroelectric Power Device
Address(number d street) 0 O 7.Geothermal Energy Heating or Cooling Device
71222(p tih 1cia 1 Via_
co City,state,ZIP code,and c unty. 9.1 ,^ 2-4-rs 3 6 ,-1 Q - b 6 61 0`t
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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