Homestead_Ramirez Jr H. PREPARER
Preparer of the Sales Disclosure Form Title
Brian K. Mahoney Attorney
Company
Address(number and street,city,state,country,and ZIP Code)
822 E Main St., Petersburg, IN 47567
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyan umen
Estate of Wilma Jean Frederick by Bradley Wayne Frederick, P.R.
Address(number and street) Address(number and street) *Ov
7184 W St Rd 56 11
City,state,and ZIP Code City,state,and ZIP Co <3
Hazleton, IN 47640 �'e6Oti ?
Country Country Co Q ��
(76
United States e./NIy"'
E-mail address
my knowledge and belief,is true,correct and complete as
required by la d in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the value of transferred
real pro ,or omits or falsifies y information required to be provided,commits a Level 5 felony.
Signatu Seller Signature of Seller
Printe Nam of Selle Date si ned(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Estate of Wilma Jean Fredenck by Bradley Wayne Fredenck,P.R. I I-1 S 'a
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
Joe Anthony Ramirez, Jr. Morgan Ramirez
Address(number and street) Address(number and street)
315 E Maple Street 315 E Maple Street
City,state,and ZIP Code City,state,and ZIP Code
Washington, IN 47501 Washington, IN 47501
Country Country
United States United States
E-mail address
YES NO CONDITION YES NO CONDITION
1 O 1.Will this property be the buyer's primary 2 O 3. Homestead
residence? O Q 4. Solar Energy Heating or Cooling System
U
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 O 6. Hydroelectric Power Device
Address(number and street) O 0 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county ZG- lid — I g - 109 -(9Q o . 31 3 - 0(D+
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
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