Homestead_Siekman l H. PREPARER
Preparer of the Sales Disclosure Form Title
D.MICHELLE ROSE LOAN PROCESSOR
Company
Address(number and street,city,state,country,and ZIP Code)
215 N MAIN ST, LYNNVILLE, IN 47619
I. SELLERS)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller,2—Name a ars on conveyance document
THREE T PROPERTIES LLC / i?J /�"�'.-7,4,._71 trI) L 6-C,
Address(number and street) Address(number 2- a/nJ .O
street) �
12322 KIDDIE RD / 3 2-2— /`/' /if" /�",
'ci./'
City,state,and ZIP Code City,state,and ZIP Code ��
LYNNVILLE, IN 47619 Z-VA-• �r /`-'4"1C' 6/
Country Country
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/ts or falsifies any information required to be provided,commits a Level 5 felony.
Signal of Seller ��A Signature of Seller�7
Pri d Nrame of Sell/ / Date si�n3ed m/dd/yyyy) P" ted N e of Selle-rr /- Date signed(mm/dd/yyyy)
THREE T PROPERTIES LLC ci�! /Za2. I y ( k`,V `. 9- -�—
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
KATLYN ROSEMARIE SIEKMAN
Address(number and street) Address(number and street) �LEI)
1010 N MAIN
City,state,and ZIP Code City,state,and ZIP Code WINSLOW, IN 47598
Country Country EP 2 9 2022
apply for certain deductions.Identifyall of tarsid ;
�l
YES NO CONDITION �,Of
1.Will this property be the buyer's primary 0✓ 0 3. Homestead
0 residence? 0 0✓ 4.Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated 0 0✓ 5.Wind Power Device
0 ✓0 for this residence? If yes, provide address: 0 0✓ 6.Hydroelectric Power Device
Address(number and street) 0 0 7.Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County �6.—/1"(— / I —/0/—coo` 7 L//6 - on-?
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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