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Homestead_Long V ' ((1. PREPARER Preparer of the Sales Disclosure Form Title Company T• - $"G 9,� 9V6, ' 7 F1e, uG-. 3e.o _ 76. 9 — I. SELLERS)/GRANTOR(S) Seller 1-Name as it appears on conve ance document Seller 2-Name as appears on conveyance document /1"i4R) ,I 5 V 6-- /NEi2 Address(number and sthe��� ��' Address(number and street) City,Itate,and ....A/•td-J ZIP CodeP�/ �� 471 !/ r7 City,state,and ZIP Code Country U 7CP J 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 any information required to be provided,commits a Level 5 felony. Sygu of -- J+/� A r Signature of Seller Printed ame of�L eller 1 ��Da et sist,ned(u ii/dd/yyyy) Printed Name of Seller Date signed (mm/dd/yyyy) ?,e/A' S , f,-xj&./e ,,it//'y/Z©ZZ— J. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY Buyer-1-Name as it appears on conve .nee document Buyer 2-Name as it appea . • •n -yam: •oc iii -0--0,''A,r L L 7 6--__.) Address(number anti-street} Address(number and street) City, tate 6 3/ZIP Code 7- City,state,and ZIP Code JAN 0 4 2022 (�R'9"VC-�-�"G ram,-FIJ Iii 7'6 9 9 / Country Country `)2.e.c/ e a.14.0. &724) . —,5'„5'17AI GIBSON COUNTY AUDITOR ( ) 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 ,,--.-YE CON ON--.,- 1.Will this property be the buyer's primary _,__ 0 3.Homestead 1 residence? 0 i., 4.Solar Energy Heating or Cooling System 2.Does the buyer have a homestead to be vacated 0 ice. 5.Wind Power Device 0 for this residence? If yes, provide address: p ///( 6.Hydroelectric Power Device Address(number and street) 0 7.Geothermal Energy Heating or Cooling Device City,state,and ZIP Code County ` .- O( ^ - / - !170 - POo• 7 ?/ -A/ 7 Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete - Page 3