Homestead_Meyer (2) IllIllIllIll
Pre r•f the Sales Disclosure Form /
Company
Address(number and street,city,state,country,and lP Cod-) . I • ��(O0
i . .
I. SELLER(S)/GRANTOR(S) Seller 2-Name as appears on conveyance document
Seller 1-Name as it appears on conveyance document
P i i j %5 G - , e-l'e-`" Address(number and street)
Address(number and street) �
2 43 j7 --- 02 S 50L4 City,state,and ZIP Code
City,state,and ZIP Code r ���v
Oe k r•wck G f 7 Country
• Telephone number
./
best of my knowledge and belief,is true,correct and complete as
required by law,
omits or falsifi and is es any in accordance
with IC 6-1.ired1-5.5.A
be provided,comm who its a Level 5 felony.owingly and intentionally falsifies the value of transferred
informat
on
real property,ure of Seller
Si• Signature of Seller
y/ Date signed(mm/dd/yyyy)
l--14f�il Date signed(mm/dd/yyyy) Printed Name of Seller
Printed Name of Seller _ .2 2 Z
Y
N .7
J. BUYER(S)/GRAN EE(S)-APPLICATION FOR PROPERTY BuyerTA DEDUCTIONS s it Pe-aDErs� clFY ALL THAT onveyance document
Bu er 1-Name as it a�ears on conveyance docum��
�e• `-" Address(number and street)
Address ' and street). - S
L •
City,state,and ZIP Code
City,state,and ZIP Code lJ i ,,, 'v
--0``' L G / -1l� C— _I C17 Country 9
v i .0.NI — �/ Telephon tuber
!J
Pursuant to IC 6-1.1-12-44,te Sales Disclosure Form may be used to apply for certain deductions.Identify al
.. 11118111111111.111
YES NO CONDITION O/, -
t YES NO CONDITION 3. Homestead
1.Will this property be the buyer's primary0 4. Solar Energy Heating or Cooling System
residence?
Device
0 5.Wind Poweri
j 2. Does the buyer have a homestead to be vacated ❑ 5.Hydroelectric Power Device
-4 for this residence? If yes,provide address:
•
i1 \ 0 7.Geothermal Energy Heating or Cooling Device
Address�nu0mber�d s re\t) / /
(� _ate 3�- go.5- 7o/- J -�
D City- ate,ZIP code,d and'courtly j o correct and
Under penalties of perjury,I h
jj-ereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,te:Both spouse'sm complete
Cr---,--...,I 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
d to
be provided,
ead Deduction ists a being filed.)
5 felony.
I
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