Homestead_Hill •
H.•PREPAkER
— _
Preparer of the Sales Disclosure Form Title _
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Company
Address(number and street,city,state,country,and ZIP Code)
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I. SELLER(s)/GRANToR(s)
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SellerZJamq as it appears on conveyance,dorument Seller 2—Name as appears on conveyance document i (1 I a- tr-N • 1 1 3 Y.. .
Address_(burer and 1 street) Address(number and street)CNC)-e_c0,-0-1- S-4-. PIZ
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Citv3State,and ZIP ..---Code City,State,and ZIP Code
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Country 1 Country
Email Address ftre4tyle Number
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Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and 41 frs' svrect,and complete as
required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentiony 'hl the val - of tr-• •rred
re I prope ,or o its or falsifie/
g
---/ 'nformation re i d to be provided,commits a Level 5 felony.
Signature of Seller
atur f ell
111.04
Pri ted.&ne of Seller , n ( m/dd/yyyy) Printed Name of Seller Date Signe. I m/dd i
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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
Address(number and street) Address(number and street)
CiWrat"1"..te,and ZIP Code 1,...../, H, ,. , ,,, City,State,and ZIP Code
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Countt,..i.,..„. ... Country
reatitigiqe,
apply for certain deductions.Identify all of those that apply:
YES NO CONDITION 7 NO CONDITION
Na/ 1.Will this property be the buyer's primary 0 , 3. Homestead
residence? 0 ry-4.Solar Energy Heating or Cooling System
c1/2. Does the buyer have a homestead to be vacated 0 S.Wind Power Device
for this residence? If yes, provide address: 0 /6. Hydroelectric Power Device
Address(number and street) 0 V 7. Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County c‘ / n
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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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