Homestead_Kellems Jr •
H. PREPARER
_
Preparer of the Sales Disclosure Form Title
Milton Norman Settlement Agent
Company
Address(number and street,city,state,country,and ZIP Code)
25 NW Riverside Drive,Suite 310,Evansville,IN 47708
I. SELLER(S)/GRANTOKS)
Seller 1-Name as It appears on conveyance document Seller 2-Name as appears on conveyance document
Mission Real Estate Group,Inc.
Address(number and street) Address(number and stre. 1
P.O.Box 543
City,State,and ZIP Code City,State,and ZIP Code
Owensvlile 47665
Country Country OCIi•
, „
US U/
Email Address Addregk , Telephone Number
„ a-
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge,,2,•• 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 I falsifies the value of transferred
real property,or g5nits or faisifi,s,r)..Vnformation required to be provided,commits a Level 5 felony.ei .2. .
Signatu,,of ae101`,., , z Signature of Seller (..)A.
/ A-id-''' „fr
F:Agred Name of:;" Oer Da.c Signed(mm/dd/yyyy) Printed Name of Seller Data Signed(mm/dd/yyyy)
/
James M.Chappell,President Itel..Ze"...•-•7
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
Daniel W.Kellems,Jr.
Address(number and street) Address(number and street)
-,
430 E Oak
City,State,and ZIP Code City,State,and ZIP Code
Princeton,IN 47670
Country Country
US
Email Address
certain deductions.Identify all of those that apply:
YES NO CONDMON YES NO CONDITION
1.Will this property be the buyer's primary ( 0 3.Homestead
(81 0 residence? 0 (331 4.Solar Energy Heating or Cooling System
. ' 2.Does the buyer have a homestead to be vacated 0 IX 5.Wind Power Device
0 011
I for this residence?If yes,provide address: 0 OD 6.Hydroelectric Power Device
Address(number and street) 0 IX 7.Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County ‘.... 2_0 ...,..2.0 ......co 0 009 ....0‘....".‘,..%
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