Homestead_Lasley (6) H. PREPARER
Preparer of the Sales Disclosure Form Title
Daphne Karmer Paralegal
Company
Address(number and street, city,state, country,and ZIP Code)
226 Broadway St., Princeton, IN 47670
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Fredrick L. Braselton Revocable Trust Lois G. Braselton Revocable Trust
Address(number and street) Address(number and stre t)
3 8JO-rA• st 4 � NW � ,tom-Q-� L,
City,state,and ZIP Code City, e,and ZIP C
Country C ntry
USA USA
E-mail address
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 transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Signature of Selle �n4� Signatu of Seller )
Print ame of er Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Robert J. Braselton, Trustee g --jam -3 Lois G. Braselton, Trustee ,-3023
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 conveyan ocument
Robert Lasley
Address(number and street) Address(number and street)
4936 W 125 S It
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670 406• 'el)
Country Country 09
USA ' ��
E-mail address
VOO&Q ( v,
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify al'�'dtyth t apply:
YES NO CONDITION YES NO CONDITION '•99V0/�,
1.Will this property be the buyer's primary 0 0 3. Homestead OR
D O residence? O 0 4. Solar Energy Heating or Cooling System
O O 2. Does the buyer have a homestead to be vacated 0 O 5. Wind Power Device
for this residence? If yes,provide address: 0 0 6. Hydroelectric Power Device
Address(number and street) O 0 7. Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
G-II- n--400 -000. 181 -021
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
5
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