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Preparer of the Sales Disclosure Form Title
Jamie E. Smith Escrow Officer
Company
-Address(number and street,city,state,country,and ZIP Code)
101 Plaza East Boulevard;Suite 102, Evansville, IN 47715
I. SELLER(S)/GRANTOR(S) D
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance documen
BENJAMIN T. KAHLE SAMANTHA JO KAHLE DEC 3
O
Address(number and street) Address(number and street) - 2022
122 Olive Drive 122 Olive Drive -1gjjS��_ ��,
City,state,and ZIP Code City,
i y,state,
a d ZIP
Code3454 G/ -O?N y.J
Princeton, IN 47670-3454 VDT FOR
Country Country
E-mail address '
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.
Signature of Seller Signature of Seller
Q` X.� — 0- £arnn.a....t-+,,c. (Icy leo.J'�Lo
Prints ame of Seller Date signed(mm/dd/yyyy) Printed Name of Sells Date signed(mm/dd/yyyy)
BENJAMIN T KAHLE December 12, 2022 SAMANTHA JO KAHLE December 12, 2022
J..BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as it appears on conveyance document
PHILIP R.THOME ANGEL R.THOME
Address(number and street) Address(number and street)
122 Olive Drive 122 Olive Drive
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670-3454 Princeton, IN 47670-3454
Country Country
E-mail address
apply for certain deductions.Identify all of those that apply:
YES/ NO CONDITION YES/ NO CONDITION
{ 1.Will this property be the buyer's primary LrJ� Q 3.Homestead
�] �
u ❑ esidence? ��/4.Solar-Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated ❑
5.Wind Power Device
❑ for this residence? If yes,provide address: ❑ 6.Hydroelectric Power Device
Address(number and street) 0 l 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county aV-12^‘ -yo3 0 02- gaol -o Z g.
Under penalties of perjury,I hereby certify that 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-
'
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