Homestead_Courtney H. PREPARER
Preparer of the Sales Disclosure Form Title
Sandra L. Hicks Attorney
Company
Address(number and street city state.country.and ZIP Code)
102 N. Elm Street. Fort Branch, IN 47648
I. SELLER(S)IGRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Horizon Property Holdings, LLC
Address(number and street) Address(number and street)
2213 E. Presley Drive
City State and ZIP Code City.State and ZIP Code
Haubstadt, IN 47639
Country Country
USA
( )
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,is true,correct,and complete as
requir 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 pr erty,or omits or f ifies an information required to be provided,commits a Level 5 felony.
Signatu of Had) Signature of Seller
Printed Name of Selle . Date gne (mm dd yyyy) Printed Name of Seller Date Signed(mm.dd'yyyy)
David F. Greubel, Member Xi/ i 3
J. BUYER(S)/GRANTEE(S)—APPLICA ON 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
Roger D. Courtney
Address(number and street) Address(number and street)
607 S. 9th Avenue No a
City. State.and ZIP Code City.State.and ZIP Code /2) .— FO
Haubstadt, IN 47639 rT" o
w
Country Country _"
Q
`'' }USA
-- --
Email Ad,'ress
NO CONDITIONin
J 1.Will this property be the buyer's primary i l ,_J 3. Homestead JJJ���
residence? O O 4. Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated O 0 5.Wind Power Device
for this residence? If yes. provide address: 0 Cl 6. Hydroelectric Power Device
Address(number and street) 0 0 7. Geothermal Energy Heating or Cooling Device
1980 Miles Road
City State.andZIP Code County
Cincinnati, OH 45231 Hamilton 24. 2 3 - O/o- D , AO. 81/3_OD 9
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
transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony. (Note:Both spouse's
Information,SSN/Driver's License/ID/Other Number is necessary only if a Homestead Deduction is being filed.)
Signature of er 1 Signature of Buyer 2 Spouse
n .._____t _ e.c/ // '/•.,�`
Printed a me of Buyer 1 n Date(MM'DD ) Printed Legal Name of Buyer 2 Spouse Si n Date(t.lr.1 DDYY)
Rogert D. Courtney A
Last 5 Digits of Buyer 1 SSN Driver's License ID Other Number Last 5 Digits of Buyer 2 Spouse :1 rovers Lipso ii, ber
ir
_ y
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