Homestead_Kolb H. PREPARER — --1
Preparer of the Sales Disclosure Form ` Title
'i Kelly E No_rton , I Settlement Agent
i Company _.
E-mail address
Address(number and street,city.state.country,and ZIP Code) —
j 4799 Rosebud Lane,Newburgh,IN 47630
L.SELLER(S)IGRANTOR(3) LIB., a.T/j
Seiler
,.-LE .._..-_.,...._..__-�.........,.docu.-..-.-... ..._..__... - ... .-_ ._�..-...._....-.n yaL L ..._. -
Seiler 1-Name as i.appears on conveyance document Seller 2-Name as appears on
'.' Christopher L.Allen Julia A.Allen
Address(number and street) [Address(number and street) AUG 2 9 2022
902 Chickasaw Dr. 902 Chickasaw Dr. _
t( City.state,and ZIP Code l City,state,and ZIP Code
1 FortBran_ch.IN 47648 j Fort Branch,IN 47648 % &.
Country — Country - • • •e , - • •• •-
us
us
best of my knowledge sad 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 falsifies any information required to be provided commits a Level 5 felony_
,ig , -i tiere:1.... i . ,T .lure of C.f.
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Printed Name of Seller Date C
si ned nun YYYY) • Name of/ S . Date signed(rnm/dd/yyyy) i
Christopher L.Allen 08/25/2022 1 Julia A.Allen 08/25/2022
g Ieiler
..-
i J. 6UYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1-Name as it appears on conveyance document 1 Buyer 2-Name as it appears on conveyance document
Jennifer Leigh Kolb _L Brandt David Kolb
'. Address(number and street) I Address(number and street)
102 S.Walters St. 102 S.Walters St.
i
City,state.and ZIP Code 1 City,state,and ZIP Code
Fort Branch, IN 47648 Fort Branch,IN 47648
Country i Country -.
US US
, _ _.
YES NO CONDITION CONDITION
M:
N ix O 1.Will thus property be the buyers primary go 0 3.Homestead
residence? , O CB 4.Solar Energy Heating or Cooling System
0O 2. Does the buyer have a homestead to be vacated I O ( 5.Wind Power Device
0 PI for this residence?If yes,provide address: 0 (, 6.Hydroelectric Power Device
0.
01 / s�,{nurpr aqd sjree), Si •
1 0 ® 7-Geothermal Energy/ ci, {ii Heating or Cooling Device
t.ii itaatte.ZIP ei.ade,and county
—i Under penalties of perjury.I hereby certify that this Sates Disclosure,to the best of my knowledge and belief is true,correct and complete
t 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
a transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
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s