Homestead_Kern H. PREPARER
Preparer of the Sales Disclosure Form Title
Matthew Jarvis Escrow Officer
Company
Address (number and street, city, state, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
I. SELLER(S)/GRANTOR(S)
Seller 1 — Name as it appears on conveyance document Seller 2 — Name as it appears on conveyance document
Koleton J. Besing Sydney R. Besing
Address (number and street) Address (number and street)
312 W Columbia St. 312 W Columbia St.
City, State and ZIP Code City, State and ZIP Code
Oakland City, IN 47660 Oakland City, IN 47660
Country Country
United States of America United States of America
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 6-1 .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.
Sign cre eller n fl/ Z Si natur of Seller ,^
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Printedj Name of Seller Date Signed (mm/dd/ Printe Name dr Seller _ Date Signed (mm/dd/yyyy)
Koleton J. Besing YYYY) Sydney R. Besing Err
9/4/2025
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�Cc� ccfnvey ce docu en
25
Arick Kern _
Address (number and street) Address (number and t et)
8774 S. Meadow Ln. GIE3ON < 2
�
City, State and ZIP Code City, State and ZIP Code �N7ti4�
Owensville, IN 47665 �; (-4-3
Country Country
United States of America
for certain deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION ,f
1 . Will this property be the buyer's primaryresidence? El ❑ 3. Homestead �*- .:.
� ❑ p p Y Y
have a homestead to be vacated for ❑ 0 4. Solar Energy Heating or Cooling System .-
❑ 2. Does the buyer a
this residence? If yes, provide address. ❑ El 5. Wind Power Device
Address (number and street) ❑ 0 6. Hydroelectric Power Device
❑ El 7. Geothermal Energy Heating or Cooling Device
City. State, and ZIP Code County
lL - 2 — OOO . —OO
4-
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 transferred real
property, or omits or falsifies any information required to be provided, commits a Level 5 felony. (Note: Both spouse's information, SSN/Driver's
License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
/