Homestead_Wilson (18) H PREPARER"
Preparer of the Sales Disclosure Form Title
Roman Ricker Attorney
Company
Address(number and street,city,state,country,and ZIP Code)
219 N Hart Street, Princeton IN 47670
I. SELLERS)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Donna Williams Jean Eads
Address(number and street) Address(number and street)
210 Hawthorne Dr 103 N. Third Avenue
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670 Princeton, IN 47670
Country Country
USA USA
E-mail address
required by law,and is prepared'in accordance with IC 6 1 1-5 5.A person who knowingly and)ntentionally-falsifies the value'of transferred
p_�p_r .
real ro e ty;or omits orfalsifies any information required to be providetl,commits;a Level;5 felony._, , ,
Signature o� Signature Seller
/Printed Name of Seller Date signed(mm/dd/yyyy) Printed(me of Seller Date signed(mm/dd/yyyy)
Donna Williams 1/7/2021 Jean Eads 1/7/2021
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
Suzanne L. Wilson
Address(number and street) Address(number and street)
801 W. Elm Street, #D Pi-
t
a
City,state,arid ZIP Code ,i City,state,and ZIP Code t
Haubstadt, IN 47639
Country Country J
USA AN 112021
E-mail address Telephone number
Pursuant to IC 6=11 12-441 the Sales Disclosure.
YES NO CONDITION YES NO CONDITION r h�Ol TAR
O 1.Will this property be the buyer's primary m O 3.Homestead -
residence? 0 WI 4.Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated 0 G2f 5.Wind Power Device
O CO for this residence?If yes, provide address: 0 WI 6.Hydroelectric Power Device
Address(number and street) O lZi 7.Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County
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