Homestead_Harison H. PREPARER
Preparer of the Sales Disclosure Form Title
Leon C. Stone
Address(number and street,city,state,country,and ZIP Code)
226 West Broadway Street, Princeton, IN 47670 ��
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyanceialgcument
Kevin Pinnick T 18
Address(number and street) Address(number and street) ZQZ2
32
W.
ale Street
City,state,and and ZIP Code City,state,and ZIP Code G/e`40nr C e-
Oakland City, IN 47660 OVNi)••4
Country Country q(/ ,
United States of America /rOp
E-mail address
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.
Signature of Setter / 2 _ Signature of Seller
2 c Y
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Kevin Pinnick / 0//- / as
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
Bernard F. Harrison Jenni Harrison
Address(number and street) Address(number and street)
5339 E 650 N 5339 E 650 N
City,state,and ZIP Code City,state,and ZIP Code
Hazleton, IN 47640 Hazleton, IN 47640
Country Country
United States of America United States of America
E-mail address
YES NO CONDITION 1� NO CONDITION
1.Will this property be the buyer's primary r,-;:) CI 3. Homestead
® D
residence? 0` p 4.Solar Energy Heating or Cooling System
O O 2. Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device
for this residence? If yes,provide address: O p 6.Hydroelectric Power Device
Address(number and street) 0 CI 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
2(,-<<l - N-303- now qo ----o0
Under penalties of perjury,I hereby certify that this Sales Disclosure,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.(Note:Both spouse's
Page 3 of 5
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