Homestead_Baehl (5) H. PREPARER
Preparer of the Sales Disclosure Form Title
Patti Kolb Closing Manager
•
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
Shelby D. Bryant
Address(number and street) Address(number and street)
4979 Katandin Way
City,state,and ZIP Code City,state,and ZIP Code
Colorado Springs, CO 80911
Country Country
USA
E-mail address
( )
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 pro (61
erty,or omits or falsifies any information required to be provided,commits a Level 5 felony.ea S atu of r n // Signature of Seller
.&i.
Printed a of Seller Date s)igned mm/dd/yy�) Printed Name of Seller Date signed(mm/dd/yyyy)
Shelby Bryant pl/i a/2oa
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 G)
Bryce A. Baehl 00
co
Address(number and street) Address(number and street) O , M
632E 1025 S = ElCity,state,and ZIP Code City,state,and ZIP Code
a CD
Haubstadt, IN 47639 z iv t-I
Country Country % N t'll
USA F, -' d
E-mail address
( ) A '-
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
lz O 1.Will this property be the buyer's primary WI 0 3.Homestead
residence? 0 (21 4.Solar Energy Heating or Cooling System
f�'O 2.Does the buyer have a homestead to be vacated 0 05.Wind Power Device
for this residence?If yes,provide address: 0 0 6.Hydroelectric Power Device
I Address(number and street) 0 (,71 7.Geothermal Energy Heating or Cooling Device
i
City,state,and ZIP Code County 26-19-31-303-000.204-009
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