Homestead_Angle (2) H. PREPARER
Preparer of the Sales Disclosure Form Title
.Sh'r 9:1., tA..t p$r.DYN Settlement Agent
Company
Address(number and street,city,state,country,and ZIP Code)
2301 N.Burkhardt Road,Evansville, IN 47715
1. SELLER S /GRANT
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Kimberly Elizabeth Shain
Address(number and street) Address(number and street)
203 S.West St.
City.State,and ZIP Code City,State,and ZIP Code
Fort Branch,IN 47648
Country Country _
US
Email Address
( )
Under penalties of perjury,I hereby certify 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 6-1A-5.5.A person who knowingly and intentionally falsifies the value of transferred
real prope 'or omits or falsi y information required:to be provided,commits a Level 5 felony.
Signet :her Signature of Seller
/• r
Prin -d Name of Seller Date Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
Kimberly Elizabeth Shain 08/22/2023 08/22/2023
J. BUYER(S)/GRANTEE(S) —APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDEN Y ALL THAT APPLY
Buyer 1-Name as It appears on conveyance document Buyer 2-Name as it appears v a document
Kyle Wesley Angle
Address(number and street) Address(number and street) El)206 West John St. _A// _
City,State,and ZIP Code City,State,and.ZIP Cod �c 2
Fort Branch, IN 47648 ?023 Country Country Gy8SON l4.- am,"C
�Q UN' �v
!V
deductions.Identify all of those that apply
YES NO CONDITION YT NO CONDITION
O 1.Will this property be the buyer's primary 0 3. Homestead
le residence? 0 EN 4.Solar Energy Heating or Cooling System
O 2. Does the buyer have a homestead to be vacated 0 (1 6.Wind Power Device
1 for this residence? If yes,provide address:
cJ 0 ® 6. Hydroelectric Power Device
JAddress(numb' rand sjteeti L.sovInS O ® 7. Geothermal Energy Heating or Cooling Device
aou.
City,State,and ZIP Code County
.[k (>f , LI 1 `6 - i. -yam .��2*1_ 2
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 6-1.1-5.5.A person who knowingly and intentionally falsifies the value of
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
.
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