Homestead_Mason (2) , .
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H. PREPARER
Preparer of the Sales Disclosure Form Title
VINOD C. GUPTA
Company
Address(number and street,city,state,country.and ZIP Code)
BOCA RATON FL 33496
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
VINOD C. GUPTA
Address(number and street) Address(number and street)
17962 FOXBOROUGH LANE
City,state,and ZIP Code City,state,and ZIP Code
BOCA RATON FL 33496
Country Country '-',704/
USA 85
best of my knowledge and ' o. ,correct and complete as
required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intenti 411y €1.k•lies the lue f transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony. "V(h., - • ..),s
Signature of Seller Signature of Seller ‘-,/i-0,9.
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller ' Date sign m d/yyyy)
VINOD C. GUPTA o_i- 1--7,
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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
DENNIS MASON BELINDA MASON
' Address(number and street) Address(number and street)
7005 E 450 N 7005 E 450 N
City,state,and ZIP Code City,state,and ZIP Code
FRANCISCO, IN 47649 FRANCISCO, IN 47649
Country Country
USA USA
E-mail address
YES NO CONDITION . YES NO CONDITION
% 0 1.Will this property be the buyer's primary CK 0 3. Homestead I
residence? 0 gl 4. Solar Energy Heating or Cooling System
NA 2. Does the .)uyer have a homestead to be vacated I D N 5.Wind Power Device
0 Val, for this residence? If yes,provide address: CI N 6. Hydroelectric Power Device
Address(number and street) 0 Ctil 7.Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County _0/ _,
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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
. ;6; .' • sf.' .:
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