Homestead_Whitehead (8) H. PREPARER
Preparer of the Sales Disclosure Form Title
JAMES G. MCDONALD III ATTORNEY AT LAW
Company
Address(number and street,city,state,country,and ZIP Code)
120 South Main Street Princeton, Indiana 47670
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as ap ears on conveyance document
Timothy W. Coomer Mary H. Loomer
Address(number and street) Address(number and street)
3179 E. Curtice Lane 3179 E. Curtice Lane
City,state,and ZIP Code City,state,and ZIP Code
Princeton, Indiana 47670 Princeton, Indiana 47670
Country Country
United States United States
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.
Si Ile Si na a Seller
y ! SNC f4� )lam�' a a
Printed Name of Seller Date,signed(mm/dd/yyyy) Printed Nam of Sell Date signed(mm/dd/yyyy)
Timothy W. Coomer jir/3o/aoek, Mary H. Coomer /,---/--z.,l
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
Spth TI_ Whi tphc arl F I 1. dress(numbYanner anand R_street)Whi tehenrl
Address(number and street)
3175 E_ Curtice Lan, 3175 E Curtice Lan,.
City,state,and ZIP Code City,state,and ZIP Code
Princeton, Indiana 47670 DEC 01 2021 Princeton, Indiana 47670
Country Country
United States € 6e G'1L ' United States
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:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary Ca L., 3. Homestead
`- residence? 0 6) 4.Solar Energy Heating or Cooling System
❑ Ar 2.Does the buyer have a homestead to be vacated 0 5.Wind Power Device
for this residence? If yes, provide address: ❑ 60 6. Hydroelectric Power Device
Address(number and street) 0 & 7.Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County 6 \ --\ — - O 00. 89'5-- 0 2. -
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete