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Homestead_Wyatt (2)
H. PREPARER Preparer of the Sales Disclosure Form Title Carla Waltman ESCROW OFFICER • Company Address(number and street,city,state,country,end ZIP Code) 331 Franklin Street, Columbus, IN 47201 I. SELLERS)/GRANTER(S) Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document THE ESTATE OF KARLA L.MOORE, By Molly L Moore, Executrix Address(number and street) Address(number and street) 2751 N SR 65 _ City,slate,and ZIP Code City,state,and ZIP Code PATOKA, IN 47666 _—._--_---- Country Country USA E-mail address Telephone number E-mail address Telephone number Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,la true,correct and complete as required by law,and la prepared In accordance with IC 8-1.1.5.5.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 6 felony. Signature of Seiler Signature of Seller Printed Name of Sailer Data signed(mm/dd/yyyy) Printed Name of Seller I Dale signed(mm/dd/yyyy) THE ESTATE OF KARLA L.MOORE 06/21/2021 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 n y e d KANE B.WYATT R J Address(number and street) Address(number and street) 2751 N SR 65 _ _ JUN g+7 L0� - Cny,state,and ZIP Code -- City,state,and ZIP Code PATOKA, IN 47666 Country _ _.—_ Country tthz.c�1( a. USA _ GIBS )N COUNTY AUDITOR E-mail address apply for certain deductions.Identify all of those that apply: YES NO CONDITION YES NO CONDITION 1:3 CI 1.Will this property be the buyer's primary © El 3. Homestead residence? 0 ✓l 4. Solar Energy Heating or Cooling System 2.Does the buyer have a homestead to be vacated El Q✓ 5.Wind Power Device CI El for this residence? If yes,provide address: D Z✓ 6. Hydroelectric Power Device Address(number and street) Q 0 7.Geothermal Energy Heating or Cooling Device City,state,and ZIP Code _T County l{0-- O 7-o 0 3. 88 4-02._ - Page 3