Homestead_John H. PREPARER
Preparer of the Sales Disclosure Form Title
Britany Bradshaw Agent
Company
Address(number and street,city,state,country,and ZIP Code)
226 W Broadway, Princeton, IN, USA, 47670
I. SELLER(S)IGRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Lori DeLong
Address(number and street) Address(number and street)
5010 W 700 S
City,state,and ZIP Code City,state,and ZIP Code
Owensville, IN 47665
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 property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Signat r of Sellgr� Signature of Seller
( .2 Yob-`►�
Pnnte Name of SelleV Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Lori DeLong . 3- I — c) j
J. BUYER(S)IGRANTEE(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
Nickolas John Haley John
Address(number and street) Address(number and street)
4328 E Bristol Dr 4328 E Bristol Dr
City,state,and ZIP Code City,state,and ZIP Code
Vincennes, IN 47591 Vincennes, IN 47591
Country Country
USA USA
E-mail address
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: o
YES NO CONDITION YES NO CONDITION cri
03
• s6 O 1.Will this property be the buyer's primary 0 3. Homestead z F7
residence? p WI 4.Solar Energy Heating or Cooling System O o �..
2.Does the buyer have a homestead to be vacated 0 m 5.Wind Power Device N r
for this residence?If yes, provide address: 0 WI 6.Hydroelectric Power Device �-
Address(number and street)
4328 E Bristol Dr 0 � 7.Geothermal Energy Heating or Cooling D0�
City,state,and ZIP Code County 26-18-17-100-001.803-021
:Vincennes, IN 47591 ���
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