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Homestead_Lewis I H. PREPARER Pran r of the Sales D isclosure Form Title hs c O \ CVOcY i Ad ress(Wm bet and street,city,state,country,and ZIP Code) -�kot0C_ V-3°Sa-\+ Avg U+-lees 1 1�SV\l(c _) Its 4-177,S I. SELLERS)/GRANTOR(S) Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conveyance document Ipi Kenneth Dossett Judith Dossett A d s(y,p ber nd.t Address(number and street) — I �!q� t 'cit (7,12k Code, City,State, ZIP Co , Country `� Country `y\fin 1/ FE8 of my knowledge and belief,is tr fj ': V . omplete as required by law,and Is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies el ir'.: r.nsferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony. a/T • Signal e of Seller • Si lure of Seller -'(+ 'rint-. a e o Sel-r Date Signed(mm/dd/yyyy) Pri d Name of Seller Date Signed(mm/ddlyyyy) Kenneth Dossett , 2• Judith Dossett .:2-, - o A 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 Levi Lewis Angelle Lewis di -ter s (nnu`mbe d ptrpe,) '^!,, Address(number and street) Nes\I rat?.t`eOapcp Coodd/�l).1 (.012 coL City,Stat,71r. - — Country itas— 1 Country• 1F/ for certain deductions.Identify all of those that apply: YES NO CONDITION YES NO NO CONDITION 1. Will this property be the buyers primary V 0 3. Homestead residence? 0 O 4.Solar Energy Heating or Cooling System 0 60,2. Does the buyer have a homestead to be vacated 0 f 5.Wind Power Device for this residence? If yes, provide address: 0 0 6. Hydroelectric Power Device Address i (n mb and street)L© N 0 t 7.Geothermal Energy Heating or Cooling Device L! '^7 II a I 'ty,State,and ZIP Code i ti County -- U —t 0 -i • 0.6 )--9 -01• Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct,and complete CPI(