Homestead_Evans H. PREPARER
Preparer of t li
Sales Disclosure Form Title S e /4/
Company
I. SELLERS)/GRANTOR(S)
Seller 1 —Nae as it appears on co veyap document Seller 2—Name as appears on conveyance documen
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Address(number and street) s Address(number and street) 144:4 64.
City, State,and ZIP Code City, State,and ZIP Code
PAihc. °10/Vs y767 6
Country Country ' G.
aSa� o,.?
accordance with IC 6-1.1-5.5.A person who knowingly and inten bya I ifies the value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony. 40,,. •
Signature eller El.
/ Signature of Seller OR
Printed Name of Seller Date Signed(mm/dd/yyyy) Printed Name of Seller
Date Signed(mm/dd/yyyy)
POi f .; G ci V t $/ -36).31
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
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Address(number and street) Address(number and street)
(‘)30 A; . 5e,-,9 ,44,siy -
City, Stat,-.and ZIP Code City, State,and ZIP Code
VA //7 ere�s- ./76 70
Country asa Country
certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
lyi O 1. Will this property be the buyer's primary 0 3. Homestead
residence? 0 71 4. Solar Energy Heating or Cooling System
O 2. Does the buyer have a homestead to be vacated 0 * 5. Wind Power Device
for this residence? If yes, provide address: O VS 6. Hydroelectric Power Device
Address(number and street) 0 lin 7. Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County
oL b't2- O T-?o ( -00 Li • 3 to -028
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Page 3 CONTRACT