Homestead_Lioyd H. PREPARER
Preparer of the Sales Disclosure Form. Title
Vl1c, v.tio- Lltjy ot.1 ere✓
Company
Address(number and street,city,state, country,and ZIP Code)
90' 50 '= 'Pv-; vtt e-t0,V, ,,-'l 41G' O
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on/conveyance document
5 rr. e s .L.l uy ri ► Gil-T 11.3._ ) UY Of
Address(number and street) Address(number and street)
29 01 ,Cu`" V f: y c.eTGN. -cnJ w'1 GA 0 2y G `% 5 0"-(---)-
City,state,and ZIP Code City,state,and ZIP Code
1?r,140,4 t OA ,-l=v-) `f 'k,'7 0 )V V. vt c e..'t ✓v ,,<-' 4,16 7 ()
Country Country
CY,NO5OA-) C.VCOnl
E-mail address
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/
,-„d 7.i(.c�
Printed Name of Seller Date signed(mm/dd/yyyy) Printdd Name of Seller Date signed(mm/dd/yyyy)
Sc-yv.es L1 oyd Aug aL, 20 2L h'lav k-Inc-- I--)ayd 0._,,, 26D, 2- u 2--,
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 conve ante documen
JPYtrt;krn }—lvyd )FI� E
Address(number and street) Address(number and street
.2U9 S. WUv1DS Si.eer
City,state,and ZIP Code City,state,and ZIP Code AUG 2 6 2022
(----
ea-A-6 X0,, mil^/ 911 (oto (e _ c?
Country Country
c'r;hsoru a.
( )
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 NO CONDITION
1.Will this property be the buyer's primary 11� 0 3. Homestead
O residence? 0 (32( 4. Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated 0 L�/ 5.Wind Power Device
O for this residence? If yes,provide address: 0 Q 6. Hydroelectric Power Device
AririrPes(number and street) O ICJ 7.Geothermal Energy Heating or Cooling Device
City,state.ZIP code,and county
p ���U 1L� Yt� y�(O G � b \J �/ _ O 2 y— � i- (D0_ J t� - 0 -0'02 ? ?._ 2
.3 � oc -
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
cr 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
el transferred real property,or omits or falsifies any Information required to be provided,commits a Level 5 felony.(Note:Both spouse's
Q
O Page 3 of 5
C0
NTRA ..i:, . „„.....,.. ,...,.::i ., ,