Homestead_Bottoms i H. PFtEPARER —1
Preparer of the Sales Disclosure Form Tate
Kelly L_Norton '_Settlement Agent
Company E-mail address
y Address(number and street,city,state,country, add ZIP Code)
4799 Rosebud Lane,Newburgh,IN 47630
I.SELLER(S)/GRANTOR(S)
e Jill L.Bottoms
Seller 1-Name as it appears on conveyance document 1 Seller 2-Name as appears on conveyance document
_
Bradley D.Bottoms __
Address(number and street) Address(number and street)
1 11148 E.700 S. 11148 E.700 S.
City.state,and ZIP Code I City,state,and ZIP Code
Oakland City,IN 47660 Oakland City,IN 47660
Country
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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 faisBRes any information required to be provided,c Its a Level 5 felony.
*Signature of Seller , ca r of S
Printed Name of Seller 1 Date signed(mrn/dd/yyyy) rtted�e I Date signed(mmrdd/yyyy)
_4 07/15/2022 f Jill L.Bottoms 1 07/13/2022
Bradley D.Bottoms �_ —
; J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY r I
I Buyer i-Name as it appears on conveyance document j Buyer 2 Name as it appears on convey nt
Tyler Bottoms -- -
1 Address(number and street) i Address(number and street)
11148 E.700 S. ` ✓�
..z
City.state.and ZIP Code __ - t C .
state:and ZIP Code Is
,464et...z -16:6...........,
Oakland City, IN 47660 . -__� 2
Country _-1 Country N O L,
' US -�Uip'y
E-mail address
- __ (_ R._
Pursuant to IC 6-1.1-12-44.the Sales Disclosure Form d to apply for certain deductions_Identify ail of those that apply:
NOCONDITION
YES - = maybe used
i YES NO CONDITION
1.Will this property be the buyer's primary f3 0 3.Homestead
® O residence? O CB 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated , 0 ® 5.Wind Power Device
i� for this residence?if yes,provide address: ! p a) 6.Hydroelectric Power Device
Address(number and street) 1
p ail 7.Geothermal Energy Heating or Cooling Device
City.state.ZIP code,and county 1 4(3-Zo -‘3 - 200 - (r)02, _O o 4 -o o t
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
Last 5 Digits of Buyer 2/Spouse SSi�t/L3river s License5D/Other Number_-
"q'. e_M1 _
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