Homestead_O'Neill H. PREPARER
Preparer of the Sales Disclosure Form Title
Melissa Dawn Baker Closer
Address(number and street,city,state,country,and ZIP Code)
226 W. Broadway Street, Princeton, IN 47670 1
I. SELLER(S)/GRANTOR(S) T�'
Seller 2-Name as appears on conve �[iocu
Seller 1 -Name as it appears on conveyance document ��
Estel W. McCarty Jr. VV
Address(number and street) Address(number and street) J(j�
310 W. Division Street 14 2p2Z
City,state,and ZIP. ode (� LOCO
City,state,and ZIP Cod6^/BSON Cn Q
..::Oa Aka jtr 147 W(� Count NryAU'�`'�
Country ry O/TOR
USA Telephone number
E-mail address
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 Signature of Seller
� Y LO'W\>e`er �J Printed Name of Seller Date signed(mm/dd/yyyy)
Printed Name of Seller C Date signed(mm/dd/yyyy)
W. McCarty Jr.
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
Connie J. O'Neill
Address(number and street) Address(number and street)
223 W. Dale Street
City,state,and ZIP Code City,state,and ZIP Code
Oakland City, IN 467660
Country
Country
USA Telephone number
E-mail address
apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary
p 0 3. Homestead
CI 0 residence? 0 E 4. Solar Energy Heating or Cooling System
t J 0 Q 5.Wind Power Device
'[Ay 2. Does the buyer have a homestead to be vacated
for this residence? If yes, provide address: 0 O 6. Hydroelectric Power Device
C .dress(number and street) 0 B 7. Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county "} 6 ,I LI --I ? -3 0(-k—Q Q O -0 2)'---00
Under penalties of perjury,I hereby certify that this Sales Disclosure,to thebest 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.(Note:Both spouse's
information,SSN/Driver's License/ID/Other Number is necessary if a Homesteadure of Buyer Deduction
is being
filed.)
S' ature of Buyer 1 ,
�` (�l�1; ham Da/3-��
anted Legal Nam f Buyer 1( Sign Date(MWDD/YY) Printed Legal Name of Buyer 2/Spouse Sign Date(MM/DD/YY)
Connie J. O N IIILicense/ID/Other Number
Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number Last 5 Digits of Buyer 2/Spouse SSN/Driver's
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