Homestead_Lewis (2) H. PREPARER
Preparer of the Sales Disclosure Form Title
KYLE R. WALTON ---
Company
Address(number and street,city,state,country,and ZIP Code)
1112 PINE MEADOW DRIVE SALEM, INDIANA 47167
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
SABRE INVESTMENTS LLC
Address(number and street) Address(number a street
P.O. BOX 3074
City,state,and ZIP Code :n:te
, ,and Z Code
CARBONDALE, ILLINOIS 62902 NTRACT
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.
Signature of Seller # .....4007.. ...., Signature of Seller
Printed Name of Se ler Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Kyle Walton, Authorized Agent _ .3 ./J/iV�04
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
DEREK MICHEAL LEWIS JESSICA ANN LEWIS
Address(number and street) Address(number and street)
708 W. SCHOOL STREET 708 W. SCHOOL STREET
City,state,and ZIP Code City,state,and ZIP Code
FRANCISCO, INDIANA 47649 FRANCISCO, INDIANA 47649
Country Country 0Fri yJ
USA USA u,
E-mail address
(o z timmi
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of thgslat OW:
YES NO CONDITION YES NO CONDITION 1
0 O 1.Will this property be the buyer's primary (21 O 3. Homestead c N u
residence? O 0 4. Solar Energy Heating or C g System �1
o - 2.Does the buyer have a homestead to be vacated C) m 5.Wind Power Device 7 v
for this residence?If yes, provide address: p WI 6. Hydroelectric Power Device
Address(number and street) 0 pJ 7.Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County q r ^1 s__\C1_2,t_vO O• 19 z_.O Q,
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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