Homestead_Herron H. PREPARER
Preparer of the Sales Disclosure Form Title
Renee Rosaleen Black Attorney
Company
Address(number and street,city,state,country,and ZIP Code)
112 N. Main Street, Princeton, IN 47670
I. SELLERS)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Jackie L. Herron
Actoga vit .arui•syeet) Address(number and street)
City,l state,and ZIPtt Code City,state,and ZIP Code
Owensville. Indiana 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.
Signs of S Iler j ��y/ Signature of Seller
�/ • /`. �����J.--7- Date signed mmlddi
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller g ( yyyy)
Jackie L. Herron 03/29/2022
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENT L T APPLY
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as it appears on conve ocu n
Christine M. Herron qpR �
Address(number and street) Address(number and slree�
9648 W. SR 165 4 2n22
City,state,and ZIP Code City,state,and ZIP Code0/e
Owensville, Indiana 47665 SONCOirN �t�CountryCountry "1Up/TOR T
USA Telephone number
E-mail address
to apply for certain deductions.Identify all of those that apply: J
YES NO CONDITION YES NO CONDITION
� � 1.Will this property be the buyer's primary
g 0 3.Homestead
residence? 0 V 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated �' 5,Wind Power Device
O for this residence?If yes,provide address: p V 6.Hydroelectric Power Device
Address(number and street) 0 c• 7.Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County ‘a C�0-o4'L‘OO_ 00` .49 6-0 2 %
COPY