Homestead_Perry H. PREPARER •
Preparer of the Sales Disclosure Form Title
EMILY E TEVAULT LOAN PROCESSOR
Company E-mail address Telephone number
LNB COMMUNITY BANK
Address(number and street,city,state,country,and ZIP Code)
PO BOX 126 LYNNVILLE. IN 47619
1 I. SELLERS)/GRANTOR(S) •
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
SUSAN B PERRY
Address(number and street) Address(number and street)
40 BRIARWOOD CIRCLE
City,state,and ZIP Code City,state,and ZIP Code
TEXARKANA.TX 75503
Country Country
E-mail address
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 an formation required to be provided,commits a Level 5 felony.
Signature of Her Signature of Seller
r(ij
4 .
Printed Na a of Se e�II r D n d m /dd/ Printed Name of Seller Date signed mm/dd/
SUSAN B PERRY Ol 12512021) ( )
J. BUYERS)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
aycr 1-1Vame s pears on conveyance document Buyer 2-Name as it appears on conveyance document
RALPH E PERRY
re et) Address(number and stF I L �,��.
975 E 750 S JJ��
City,state,and ZIP Code City,state,and ZIP Code
FORT BRANCH. IN 47648 FEB 10 2021
Country Country f'�, ,
E-mail address
GIBSON COUNTY 'UDI •R
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 N
❑ ❑ 1.Will this property be the buyer's primary r❑ ❑ 3.Homestea
residence? ❑ ❑r 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated ❑ El 5.Wind Power Device
❑ El for this residence? If yes,provide address:
� ❑r 6.Hydroelectric Power Device
Address(number and street)-750 s ❑ ❑✓ 7.Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County
XctVLcl/•, 1N LMUL[ .24 -19- do -/40- 600. -795-ods
Under penalties of perjury,I hereby certify that 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 orfalsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
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