Homestead_Blaize H. PREPARER
Praparorof the Sales Disclosure Form Title - -- ----------
AmvB.Pollard sen|mmentAuvnt
Company
Address(number and street,city,state,country,and ZIP Code)
78�os�g|a�r�o�8|vd.Suito2n1.�vonsvU|a.|m4771a
. '
1. SELLERfSi/GRANTOR(S)
Seller I -Name oo |t appears on conveyance document SaUero-Nomnasoppeamonconveyon
Matthew VK Skeen,/| ootw|vnC,mwfond'Gkewn �
°�
. Address(nvnnuerand oteeq = ,�xuu,evs numu�r�mun� =�> - �vn°
n1oMm auaot 915 Mill Street �4��
City,State,and ZIP Code City,State,and ZIP
Phnoomn.|N47n7o Phncamn. |w47s7u -'
�
Country Country wm �
us Ua O��
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.
Sig ,Seller aiT f S Iler
Printed Name ofSeller Date Signed(nnm/du0yyy) Printed Name or /p Da�a�noo(mm��yyyy)
�auhewYx��oon.|| o7/14/�oua ce�e|ynorm^rorB��hoen 07/14/2023
J. BUYEB(8)/GRA0TEE(S) -APPL|CAT|ON FOR PROPERTY T/\x DEDUCTIONS-IDENTIFY ALL THAT APPLY
'-
Buyer 1-Name aoit appears nn conveyance document Buyer 2-Name asit appears qn conveyance document
Phv|/ioD|aizo
Address(number and street) Address(number and street)
. 3OON.Polk SL.Trailer e
City,State,and ZIP Code City, State,and ZIP Code
Fort Branch, |N47o4V
� Country Country
US
( >
-- - -' ' - ' - i
Pursuant u,IC 6-1.142-44,me Sales_Disclosure Form may/e used_up.apply for certain deductions.Identify all orthose that apply: _ )
YES NO oowoITxaw YES NO oomo|TIom
IN O 1.Will this property be the buyer's primary C0 03. Homestead
residence?
[] 0 4'Solar Energy Heating or Cooling System
[] �h 2. Does the buyer have o homestead to be vacated 0 C0 5'VWnd Power Device
for this residence? |f yes, provide address: [] (2) G. Hydroelectric Power Device
Address(number and street) [] OQ 7'Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code county
Under penalties n,perjury,|hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct,and complete