Homestead_Randall •
H. PREPARER
Prep Tit-of the Sales iIclosure Form fog q ` 1 Title
Company y� r
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Address(number and street,city,state,country,and ZIP Code) C'
IDS i I F sv. r-`. R ,-j IA
I.SELLER(S)/GRANTOR(S)
Seller( Name as it ap,p,ears on conveyance document Seller 2-Name as appears onconvnince document
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Address(number and street) Address(number and street) �2 '
/SD0, t .ICQ(a'n.� 1�. /a9 ke(a .1--,
Ci state,and ZIP Code C' ,state,and ZIP Code
(AOt�rc�e �Y\ 2T,r/ -17 i a,a C6t°o rq e kacciek —.t} 4? r a a-
Country Country /
Fie Y ,
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best ofliny 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.
S
ignature
€�Sel r Signatu/reQQQ�f Seiler n
, ,1�C,p. ,
yyyy) N Date signed(mm/dd/yyyy)
me of Sell r Date signed(mm/dd/ Printed ame of Seller 9 ( YYYy
✓/ _ c� �0.5 \3-a.o�a Zils�t, A .-V(- 0-;---\a oaa-
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1-Name as jt appears o onveyan a do ument Buyer 2-Name as it appears on conveyance document
less ` ck� � (� _ FILED
Address(number and street) ` Address(number and street)
to S 6 _ N✓a i lv \A� 6 c City,state,and ZIP Code
City,state,and ZIP Code MAY 1 3 2022
Country Country
for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
cd 1.Will this property be the buyer's primary /e/ 0 3. Homestead
O residence? 0 ! J 4.Solar Energy Heating or Cooling System
-1 2.Does the buyer have a homestead to be vacated 0 5.Wind Power Device
O W for this residence?If yes,provide address: 0 VI 6.Hydroelectric Power Device
Address(number and street) 0 (4 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county O - t U-l3 -ijQI l -coo _ s -026
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
COPY