Homestead_Herring H. PREPARER
Preparer of the Sales Disclosure Form I Title
Daniel A.Moon Attorney at Law
Company
Address(number and street,city,state,country,and ZIP Code)
111 N Hart Street,Princeton, Indiana USA 47670
I. SELLERS)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on cony an d e
Larry G Flora
Address(number and street) Address(number and street)
864W550N ,O
City,state,and ZIP Code City,state,and ZIP Cod (II e f
Pat ka, IN 47666
Country Country DSat,
USA
E-mail address
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,is true,correeot 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 ture o f 17.— Signature of Seller
Printe ame of Seller D e si ne, (mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Larry G. Flora
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
Douglas R.Herring
Address(number and street) Address(number and street)
1101 E Water Street
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670
Country Country
USA
E-mail address
( )
Pursuant to IC 6.1.1.12.44,the Sales Disclosure Form may be used to 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 ❑� ❑ 3. Homestead
residence? ❑ 0 4.Solar Energy Heating or Cooling System
El El for
Does the buyer have a homestead to be vacated El ❑✓ 5.Wind Power Device
for this residence?If yes,provide address: ❑ 0 6.Hydroelectric Power Device
Address(number and street) ❑ El7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
2-0� .-3101--o02. o 4—O 2-9.
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
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