Homestead_Holzmeyer H. PREPARER - :•
Preparer of the Sales Disclosure Form Title
_Sherry Boatwright Settlement & Quality Assurance
Company
Address(number and street,city,state,country,and ZIP Code)
3930 Mezzanine Dr, Suite C, Lafayette, IN 47905
1.SELLER(S)/GRANTOR(S) • ..
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Rebecca K. Weber
Address(number and street) Address(number and street)
209 N 5th Ave
City,state,and ZIP Code City,state,and ZIP Code
Haubstadt, IN 47639
Country Country
USA
best of my knowledge and belief,is true,correct and complete as .:
required by law,and is prepared,ln_accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the.value of transferred..
realproperty,or omits or falsifies any
information required to be provided,commits a Level 5 felony.
Sign ye of Seller .� Signature of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mmlddlyyyy)
Rebecca K.Weber 2/10/2021 — _
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
Devin J. Holzmeyer
Address(number and street) Address(number and street)
100 South Damosa Drive
City,state,and ZIP Code City,state,and ZIP Code
Haubstadt, IN 47639
Country Country
USA
{ )
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 ap
YES NO CONDITION YES NO CONDITION To
0 0 1.Will this property be the buyer's primary WI 0 3.Homestead
m Pm
residence? 0 WI 4.Solar Energy Heating or Cooling Syz 6 H
p
0 2.Does the buyer have a homestead to be vacated t 5.Wind Power Device
•� N l
for this residence?If yes,provide address: 0 li 6.Hydroelectric Power Device D °�
Address(number and street) 0 i l 7.Geothermal Energy Heating or Coolies ice
o •-
City,state,and ZIP Code County 26-18-36-403-000.301-009
co
Page 3