Homestead_Hicks H. PREPARER
Preparer of the Sales DisclosurA Form Title
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Address(number and st etstate, ountdWe)
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I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
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Address(number and street) Address(number and street)
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Ci state,and ZIP Code City,state,and ZIP Code
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095-.0,74
Country / Country
Und
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge find 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 f Seller Signature of Seller
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Date signed(mm/dd/yyyy)
Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller 9
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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
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Address(numberri and street) Address(number and street) 4)
900 5 /HaM `5-7/- City,state,and ZIP Code
City,state,and ZIP Code
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Country
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E-mail address
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Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply
for certain deductions.
NO CONDITION Identify all of thosethat pply
-YES NO CONDITION YE0
3.Homestead
1.Will this property be the buyer's primary Er
residence? 0 Q' 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated
0 B" 5.Wind Power Device
for this residence? If yes, provide address: 0 [Er 6.Hydroelectric Power Device
Address(number and street) 0 0
1 "7.Geothermal
Energy Heating or CoolingDevice
City,state,ZIP code,and county Q�6- `$-2�-�vL 000. -(�2- 02-C3
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
COPY