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Homestead_Byrns H. PREPARER Preparer of the Sales Disclosure Form Title Leon C. Stone President Company E-mail address Address(number and street,city,state,country,and ZIP Code) 226 West Broadway Street, Princeton, IN 47670 I. SELLER(S)/GRANTOR(S) Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document Estate of Tamara S. Fetcher Address(number and street) Address(number and street) 784 E SR 56 City,state,and ZIP Code City,state,and ZIP Code Hazleton, IN 47640 Country Country United States of America E-mail address ( ) Under penalties of perjury,I hereby certi 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 property,or omits or falsifies any Information required to be provided,commits a Level 5 felony. Sign e of Seller Signature of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy) Curtis K.Cain,Personal Representative 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 Rachel Byms Address(number and street) Address(number and street) 122 Kentucky Street City,state,and ZIP Code City,state,and ZIP Code Hazleton, IN 47640 Country Country United States of America E-mail address ( ) 0 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: 83 YES NO CONDITION Y,_E,S • NO . CONDITION p _co n iii ©// 1.Will this property be the buyer's primary (Sd CI 3.Homestead - tr residence? 0 l 4.Solar Energy Heating or Cooling System• z cc {{{.H��� N 0 2.Does the buyer have a homestead to be vacated l71 5.Wind Power Device N tli 0 Ll for this residence?If yes,provide address: 0 C,d 6.Hydroelectric Power Device o d to Address(numbe and street) 0 �7.Geothermal Energy Heating or Cooling D ,, 3_, )C L� .. o O Ci , t e, nd IP Code ( n (� Caunty o ri 26-02-58-018-003.180-018 CO.0. Page 3