Homestead_Moore (14) H. PREPARER
Preparer of the Sales Disclosure Form Title
Kid Stinson Title Agent
Company
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 conveys d c . eryt
Kimberly A. Catiller an �
Address(number and street) Address(number and street)
120 W. Short Street-Apartment 200 '/,
City,state,and ZIP Code City,state,and ZIP Code
Owensville, IN 47665 04s, �
Country Country � �J2 (\
United States of America CO ' "(, v,
person who knowingly and intentionally falsifies t e value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Si lure pf Sel r Signature of Seller
Printed Name of eller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Kimberly A. Catiller C- 4.- vq 3 ,a),21
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
Shawn Patrick Moore
Address(number and street) Address(number and street)
1841 W. Essex Place
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670
Country Country
United States of America
E-mail address
apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary O 0 3. Homestead
O O 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: 0 O 6. Hydroelectric Power Device
Address(number and street) 0 O 7.Geothermal Energy Heating
-/or/Cooling Device
City,state,ZIP code,and county ���'l _ I g -'L.�)3 - 000. 0 Tb_ e 2-8>
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best ofmy knowledge and belief,Is true,correct and complete
copy