Homestead_Miskell H. PREPARER
Preparer of the Sales Disclosure Form Title
Melissa D. Baker Searcher
Company
Address(number and street,city,state,country,and ZIP Code)
226 W. Broadway Steet, Princet, IN 47670
I. SE )/GRANTOR(S)
Seller 1-Nam yc d ED
1-Name as it appears on conveyance document Seller 2-Name as appears on con ume
Leonard Shipley Dina Shipley
Address(number and street) Address(number and street)
108 N East Mill Street 108 N. East Mill Street MAR 22 2022 _
City,state,and ZIP Code City,state,and ZIP Code
Patoka, IN 47666 Patoka, IN 47666Ifw," ayr,4;,r&
Country Country GIBBON COUNTY AUDITOR
USA 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.
Signatur S er Signature bf Sellerak .,
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Leonard Shipley 3/,a (9.a Dina Shipley (94/0c949aa
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
Michael D. Miskell Wyatt F. Miskell
Address(number and street) Address(number and street)
103 N East Mill Street 103 N East Mill Street
City,state,and ZIP Code City,state,and ZIP Code
Patoka, IN 47666 Patoka, IN 47666
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:
YES NO CONDITION YES NO CONDITION
O O 1.Will this property be the buyer's primary O 0 3.Homestead
residence? 0 O 4.Solar Energy Heating or Cooling System
O 2.Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device
for this residence? If yes,provide address: 0 O 6.Hydroelectric Power Device
Address(number and street) 0 O 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county co:). 3G5-oc o
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