HomeMy WebLinkAboutHomestead_Chambers H. PREPARER - - 3
Preparer of the Sales Disclosure Form j Title
, Kelly E Norton Settlement Agent
Company Email Address (
Address (number and street, city, state, country, and ZIP Code)
4799 Rosebud Lane, Newburgh, IN 47630
I. SELLER(S)IGRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2 - Name as appears on conveyance document
Kimbra D. Parker Kent A. Mann
Address (number and street) Address (number and street)
4640 Huntington PI 2696 W 1300 S
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City, State, and ZIP Code City, State, and ZIP Code
Evansville, IN 47725 Haubstadt, IN 47639
Country Country
t US US
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.
Signs ur ir Seller pck_itA... I Signature of Seller `-;
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Print d Name of Seller Date Signed (mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
Kimbra D. Parker 02/12/2026 Kent A. Mann , 02/12/2026
J. BUYER(S)/GRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY . . THAT APPLY
Buyer 1 - Name as it appears on conveyance document Buyer 2 - Name as it appears on .. 1- '-y.n .• rnent -
Lane T. Chambers
Address (number and street) Address (number and street)
100N. Main St. `C_
City, State, and ZIP Code City, State, and ZIP Cod , 41111
Fort Branch, IN 47648
Country - — — Country ----/e '
US S°arCO,
,
for certain deductions. Identify all of • 1,, at apply:
YES NO CONDITION YES NO CONDITION
-/ 0 1. Will this property be the buyer's primary X (t 3. Homestead
residence?
O ® 4. Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated ; O ® 5. Wind Power Device
for this residence? If yes, provide address: 0 ® 6. Hydroelectric Power Device
Address (number and street) 0 () 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County ,-Z Z -i Cr 400 _ _
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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
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H. PREPARER i
Preparer of the Sales Disclosure Form Title
Claire Kincaid Closing Agent
Company E-mail address : Telephone number
Bosse Title Company claire.kincaid@jeffbosse.com . ( ) 812-421-4000
Address (number and street, city, state, country, and ZIP Code) - 4
4799 Rosebud Ln., Newburgh, IN 47630
I. SELLERS)/GRANTOR(S)
i
Seller 1 -Name as it appears on conveyance document I Seller 2 - Na a as pp ars on conveya docuillent
Kirk D. Mann la jt 00_
Address (number and street) Address (number and t)
/ ' WO ifil 0 ititil aDr '
Crate, Cr �d ZIP � e � A. 1. �2 r� City, state, � ZIP Go1de `�yam/
s /- 11-1 /"f /0 `-i:76 -1 .
Country / Country
USA 'USA
E-mail address Telephone number E-mail address Telephone number
kirkmann15@gmail.com mail.com ( ) 812-484-9992 i'
�.� c8i� ysI-G���
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. _
Sigeleigellek Signet f Seller
Printed Name of Seller Date signed (mm/dd/yyyy) Pn t-• Na • of i-per signed (mrn/dd/yyyy)
Kirk D. Mann 7--- Li-2 b Z U f air - + — V I A rD tor) ci2 /z/r2
iefil
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 convey ument
Lane T. Chambers 1 4
Address (number and street) Address (number and street)
City, state, and ZIP Code City, state, and ZIP Code /(ev
I - v i -
4%
Country Country r ( �Q ,
.�
USA USA 0/& �� __
E-mail address Telephone number E-mail address `SO4, Telephone number
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Pursuant to IC 6-1.1-12 4, the Sales Disclosure Form may be used to apply for certain deductions. Identifyltriaf at appty: _
YES NO CONDITION J YES NO CONDITION O/T '
1. Will this property be the buyer's primary ❑ 0 3. Homestead O�
❑ a residence? ❑ 0 4. Solar Energy Heating or Cooling System
Cl 2. Does the buyer have a homestead to be vacated ❑ 0 5. Wind Power Device
for this residence? If yes, provide address: ❑ 0 6. Hydroelectric Power Device
Address (number and street) 0 0 7. Geothermal Energy Heating or Cooling Device
City, state, ZIP code, and county-
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, SSNIDriver's License/ID/Other Number is necessary If a Homestead Deduction is being filed.) _
Signature of Buyer 1 ' Signature of Buyer 2/Spouse
Printed Legal Name of Buyer 1 Sign Date (MM/DD/YY) Printed Legal Name of Buyer 2/Spouse Sign Date (MI41/DD/YY)
Lane T. Chambers
Last 5 Digits of Buyer 1 SSN/Drivers License/ID/Other Number Last 5 Digits of Buyer 2/Spouse SSN/Driver's Ucense/lD/Other Number
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