Homestead_Keil H. PREPARER
Preparer of the Sales Disclosure Form Title
Shelby Head Closing Agent
Company
Address(number and street,city,state, country,and ZIP Code)
4905 Theater Drive, Evansville, IN 47715
I. SELLERS)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveya o t
Charlotte A. Reed
Address(number and street) Address(number and street) Jt
,80
C ty,State,an IP Code City,State,and ZIP Code 0k 0
Country Country
USA O/eSpN
c„
E-mail Address
` quo
17
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,Is true,correct aQtpcomplete 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
eAd.Lia Q. o�
Printed Name of Seller Date Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
Charlotte A.Reed October 30, 2023 October 30, 2023
J. BUYER(S)IGRANTEE(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
Matthew A. Keil
Address(number and street) Address(number and street)
11695 North County Road 1200 East
City,State,and ZIP Code City,State,and ZIP Code
Evanston, IN 47531
Country Country
USA
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 ❑ 3. Homestead
residence? ❑ 15i 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) ❑ 7.Geothermal Energy Heating or Cooling Device
City,State,ZIP code,and County 2 �-
- 1. - - z�
(03-,000 . , - Co 5
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