Homestead_Nash H. PREPARER
Preparer of the Sates Disclosure Form Title rA����,
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Company
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Address(number and street,city,state,country,and ZIP Code)
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I. SELLER(S)/GRANTOR(S)
Seller 1{-Name as It appears on conveyance document Seller 2-Name as appears on conveyance document
E. t Jh - - - Address(number and street)
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(number andv street)
i OO t �0�4 'SD� ����O City,state,and ZIP Code
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C�'sty,state,andZIP Code
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P ' n CO l 1 . -iT- Country i '
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Country
E-mail address
the best of my knowledge and belief,Is true,chide 4jid 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
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Printed Name of Seller Date signed(rnm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
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J. BUYERS)/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
F r_e A . NI ASI-
Address(number and street) Address(number and street)
BIB E. emerSo St.
City,state,and ZIP Code City,state,and ZIP Code
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Country Country
E-mail address
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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 CONDITION YES NO CONDITION
1.Will this property be the buyer's primary 0 3. Homestead
residence? 0 g 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated 0 X 5.Wind Power Device
0 RC for this residence?If yes,provide address: 0 `C 6.Hydroelectric Power Device
Address(number and street) 0 7. Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
D6-12- os - l03 -00\ . 313 - 029 .
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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