Homestead_Umpleby H. PREPARER
Preparer of the Sales Disclosure Form Title ATTORNEY AT LAW
JAME G MCDONALD, III
Company
Address(number and street,city,state,country,and ZIP Code)
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
LINDA HAUBOLD
Addrest(purrtaempdslreat) AVE Address(number and street)
City,state���i,e� q INDIANA 47670 City,state,and ZIP Code
Country F' IU`�NITEDD�VSTATES Country
E-mail address
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.
Sig ture of Seller j '7/ Signature of Seller
Pr nted Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller 1.4Dat i ed(mm/dd/yyyy)
LINDA HAULBOLD c)S-1121 ZuZ3
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIO S-IDENT�//LL
F'Y,,e��t THAT
Buyer 1—Name as it appears on conveyance document Buyer 2—Name a ears on conv yan4y •--nt
DANNY UMPLEBY 46,6
Addres2orfflor ftsyet) Address(number and strAITO
City,staj �p{ia Cpc�IANA 47666 City,state,and ZIP Code '9(� /TOR
t' ��nnHH I I�
Country Country
UNITED STATES
E-mail address
certain deductions.Identify all of those that apply:
YES NO CONDITION YES/ NO CONDITION
d O
1.Will this property be the buyer's primary O/ 3.Homestead
residence?
0 3/ 4.Solar Energy Heating or Cooling System
O I� 2. Does the buyer have a homestead to be vacated O 5.Wind Power Device
for this residence? If yes, provide address: 0 (3/ 6. Hydroelectric Power Device
Address(number and street) 0 7.Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County /J
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete