Homestead_Roth H PREPARER4
Preparer of the Sales Disclosure Form Title
Roman Ricker Partner
Company
Address(number and street,city,state,country,and ZIP Code)
219 N. Hart Street, PO Box 13, Francisco, IN 47649
I.SELLER(s)/041ANtoRIS).-.
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Brian Eilert
Address(number and street) Address(number and street)
2978 N. CR 700 E.
City,state,and ZIP Code City,state,and ZIP Code
Winslow, IN 47598
Country Country
Gibson County, 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 bylaw,and is prepared in accordance with IC 6 1 7-5 5 A person who knowmglyand intentionally falsifies;the value of transferred
real property,-or omits orfalsifiesany mfo matron required:to be provided,commits.,a Level 5 felony: -
Si nature of Seller Signature of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Brian Eilert 2/16/2021
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 o ya fogt
Kaitlyn G. Roth
Address(number and street) (number number and stre .t`
792 E 950 S
City,state,and ZIP Code City,state,and ZIP Code FEB 1.8. 2021
Haubstadt, IN 47639
Country Country
Gibson County, USA j'� 1/r��DII
f)2411i COUNTY AtiJITOR
( )
Pursuant toIC 6 1.1-12-44 the Sales Disclosure,Form maybe used,to.apply;for,certain_deductions.Identify;alll of thosethat apply _
YES NO CONDITION YES NO CONDITION
O 1.Will this property be the buyer's primary (I O 3. Homestead
residence? O WI 4.Solar Energy Heating or Cooling System
O 2. Does the buyer have a homestead to be vacated O (21 5.Wind Power Device
GZ for this residence? If yes, provide address: O (I 6. Hydroelectric Power Device
Address(number and street) O WI 7.Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County
�6 -06 16 aoo 003 Did
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