HomeMy WebLinkAboutHomestead_DMellow H. PREPARER
Preparer of the Sales Disclosure Form Title
Jeff Bosse Settlement Agent _
Com an _- P Y E-mall address (
Bosse Title Company
Address(number and street,city,state,country,and ZIP Code)
4799 Rosebud Lane,Newburgh, IN 47630
I. SELLERS)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on vey((( ocu t
Justin Ray Graham
Address(number and street) Address(number end street) Q
UG --b
406 N.Hull St. i 0.
City,state,and ZIP Code City,state,and ZIP Code- � 2 0Zz
Fort Branch,IN 47648 Uou f'/BSAQ 1
CS ntry Country Co(JNTy U OQvuvlll
E-mail address
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.
Siqratur of Seller Signature of Seller
Printed Nailerf Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mmidd/yyyy)
Justin Ray Graham 08/05/2022 08/05/2022
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
Jesse M.DMellow
Address(number and street) Address(number and street)
8316 83rd St.SW Apt 522
City,state,and ZIP Code City,state,and ZIP Code
Lakewood,WA 98498
Country Country
to apply for certain deductions.Identify all of those that apply: -
be the buyer's primary l 0 3. Homestead
residence? 0 ® 4.Solar Energy Heating or Cooling System
.1� 2.Does the buyer have a homestead to be vacated 0 CB 5.Wind Power Device
for this residence? If yes,provide address: p Ida 6.Hydroelectric Power Device
Address(number and street) 0 (D 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
a6 VI-ig -3o2-coo-gt1 - o2
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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