Homestead_Przymus H. PREPARER 2
' Preparer of the Sales Disclosure Form
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Company
Addr- s(number and street,city,state,co.ntry,and ZIP Code)
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I. SELLER(S)/GRANTOR(S
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
MCLP Asset Company, Inc.
Address(number and street) Address(number and street
75 Beattie Street Suite 300
J 111
City,State,and ZIP Code City,State,and ZIP Code
Greenville, SC 29611_
Country Country SEP 2 8 2023
,USA ..2
knowiedgtaiWbolief,Is true;qaq complete as
required by law,and is prepared in accordance with IC 6.1.1-5.5.A person who knowingly and intentionally falsifies 1Fii a of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
• Signet e of Seller Signature of Seller
Printed N• Seller Date Signed(mm/ddryyyy) Printed Name of Seller Date Signed(mrniddlyyyy)
I JASON BRAXTON — aV 8/30/2023
L 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
j SAMUEL T. PRZYMUS
Address(number and street) Address(number and street)
112 N Center St
City,State,and ZIP Code City,State,and ZIP Code
Francisco, IN 47649
Country Country
USA
Em�a}l ddress
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Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply:
YES NO CONDITION Y NO CONDITION
1.Will this property be the buyer's primary • D 3.Homestead
® esidence? El g 4. Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated 5.Wind Power Device
for this residence?If yes, provide address: n 6.Hydroelectric Power Device
Address(number and street) LI al,
7.Geothermal Energy Heating or Cooling Device
Cay,State,and ZIP Code County 1
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