Homestead_Bushnell ------,_
- H. PREPARER
Preparer of the Sales Disclosure Form Title
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Company
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Address(number and street,city,state,country,and ZIP Code)
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on co ,,'e-/ document
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Address(number and street) Address(number and street)
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City,State,State,and ZIP Code City, State,and ZIP Code 414/P 0
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..,. ... . 2023
Country,V Country
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of my knowledge and belief,is truSVia-ct,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 e value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Sign re of Seller g
.._ Signature of Seller
Printed Name f oe er Date Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
Li:1.M-<-••• 4. k-(-0,--ko,,,.. 051.2,5/202.3
-
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1-Name as it appears on conveyancdocument Buyer 2-Name as it appears on conveyance document
V.Y‘kk ‘01/40C1 INA - 13115\Thel ( LyMIC M , LIS‘ine-k- (
Address(number and street) Address(number and street)
I-1 I CI ot,441 c)tc .e. S-i--‘ '-/ ig ScLA-6 Pck City,State,State and ZIP Code - City, State,and ZIP Code
P n c_e_A-01-‘ /-X.1\1, 4-.1(0`70 -Pr i ne2-4-or/ l_k) 4"go 70
Country Country
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary K 0 3. Homestead ....i ,;.•
1'it,, ev, .:.....
residence? 0 (gi 4. Solar Energy Heating or Cooling Syste
0 4,,..u.( 2. Does the buyer have a homestead to be vacated 0 N. 5.Wind Power Device I .nee; ..,..44i!,.4-
for this residence? If yes, provide address: Li X 6. Hydroelectric Power Device ,v
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Address(number and street) 0 /K 7. Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County (:)\ _ 0—(.._ Lk QS _ 0 0 s .24C _ 0 23
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
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