Homestead_Folsom H. PREPARER
Preparer of Sales Dismiss rye• or .�- Title r
Com a
�
Add ss(n ber and street,city,state,counyv,and ZIP Code)
I. SELLERS)/GRANTOR(S)
Selle�l Name as it appearsor conveys ce document Seller 2-Name as appears on conveyance document
Addressl/ (�ber and street) IlO4 Address(number and street)
I ( c,>o o k.Y3'Lex—
Cit ,state,and ZIP Code _ City,state,and ZIP Code
fyirl
ouu ttry Country
t9•PSOvt TT
on
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 falsifteAti a value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony. b 2022
_-- • - •►- er Signature of Seller ,�-_`�slgn''n e. Napie of Sell Q��\ Date�signe�mm/dad/ yy) Printed Name of Seller GIBSON OUNTY AUDITOR
IYdC�YY)
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1-Name a_sgppears on conveyance document Buyer 2-Name appears on ceivveyancrocument
nu er an s ree Address(number d street).
i23(eS3' E, r o0 s, r96S 0�. . • 76-v g .
City,state,and ZIP Code City,state,and ZIP Code
Oakta hd e y. wit/. 1-f76 6 O / n Slay() Ztf✓. '174- q (
Country try
E-mail address Telephone number
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 CONDITIONit Y 1T1AtL_�
0 1.Will this property be the buyer's primary �A3.Homestead
residence? 0 0 4. Solar Energy Heating or Cooling System
0 2.Does the buyer have a homestead to be vacated 0 0 5.Wind Power Device
for this residence?If yes,provide address: 0 0 6. Hydroelectric Power Device
Address(number and street) 0 0 7. Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County
026 -14/-/8- SOY -0 00. /< 7 -c7 c,
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
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