HomeMy WebLinkAboutHomestead_McGregorH. PREPARER
Preparer of the Sales Disclosure Form
Title
Matthew Jarvis
Escrow Officer
Company
E-mail address
Telephone number
Southwestern Indiana Land Title
matt@swinland.com
(812) 425-0055
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)IGRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as it appears on conveyance document
Zachary S. Keller
Kimberly S. Keller
Address (number and street)
Address (number and street)
921 S Hall St
921 S Hall St
City, State and ZIP Code
City, State and ZIP Code
Princeton, IN 47670
Princeton, IN 47670
Country
Country
United States of America
United States of America
Email Address
Telephone Number
Email Address
Telephone Number
zkeller@live.com
(812) 582-0847
KimKeller1620@gmail,com
(812) 677-1549
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 64.1-5.5. 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.
Si nature of Seller
Si n to Qf Seller
rinted ame of Seller
Date Signed (mm/dd/ •
Printed Name of eller Date Signed (mm/dd/yyyy)
Zachary S. Keller
yyyy)
Kimberly S. Keller 10/7/2026
10/7/2026
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 ocume
Lisa J. McGregor
Patricia D: Vanoven OCT O2�
Address (number and street)
Address (number and street)
612 E Kentucky St.
916 S Hall St
City, State and ZIP Code
City, State and ZIP Code C��
/
Princeton, IN 47670
Princeton, IN 47670 �.
Country
AUDITOR
Country
United States of America
United States of America
Email Address
Telephone Number
Email Address
Telephone Number
II /% _ bq -7
PDV51 @hotmail.com
(812) 677-0174
Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION YES — NO CONDITION
3. Homestead
i ❑ 1. Will this property be the buyer's primary residence? l ❑
❑ 2. Does the buyer have a homestead to be vacated for ❑ 0 4. Solar Energy Heating or Cooling System
this residence? If yes, provide address: ❑ 0 5. Wind Power Device
❑ Q 6. Hydroelectric Power Device
Address (number d street)
�L ❑ R1 7. Geothermal Energy Heating or CoolingDevice
City, State, and ZIP Code County 1 Q�l, ���
C�� GZQ- 1-1- lU -
ii� TG+n �/1i C? i .
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
in with IC 6-1.1-5.5. A person who knowingly and intentionally falsifies the value of transferred real
required by law, and is prepared accordance
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 flied.)
Sin ure of BuyePL,
�ignaMe---o-f��Buye�2/S f e
Nrz
Printed Legal Name of Buyer 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
10l7/2026
Lisa J. McGregor 10/7/2026
Patricia D. Vanoven
Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
SSN: i n I `K D I Al Dc . U72.
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