Homestead_Kruse (8) H. PREPARER
Preparer of the Sales Disclosure Form Title
Pamela Partenheimer Mick Attorney
Company
Address(number and street,city,state,country, and ZIP Code)
219 N Hart St, PO Box 13, Princeton, IN 47670
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on
Anthony Hasselbrinck 1 ■L {L�
Address(number and street) Address(number and street)
4607WCR125S
City,state,and ZIP Code City,state,and ZIP Code DEC 1 4 Z022
Petersburg, IN 47567 '/'
Country Country `924ciz�( & YYa �
PIKE Telephone number
.
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.
Si n re of....S ler Signature of Seller
Printed Name of Seller Date signed(mm/dd/yyy y) Printed Name of Seller Date signed(mm/dd/yyyy)
Anthony Hasselbrinck / r -a3- 7
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
Chance Kruse
Address(number and street) Address(number and street)
2795 E 600 S
City,state,and ZIP Code City,state,and ZIP Code
Fort Branch, IN,47648
Country Country
( Sr
to apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
O O 1.Will this property be the buyer's primary O 0 3. Homestead
residence? O O 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device
O for this residence?If yes, provide address: O C) 6.Hydroelectric Power Device
Address(number and street) 0
p 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county )(- Q 3-300 - GO 2. 5 O3 - 0 2
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
3 of 5 c py