Homestead_Stapleton H. PREPARER
'Preparer of the Sales Disclosure Form Title
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Company / Email Address Telephone Number
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Address(number and street,city,state,countrytand ZIP Code)
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I. SELLERS)/GRANTOR(S)
Seller Name as it aps�ars on conveyance document Seller 2-Name as appears on conveyance document
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Addr ss(number and street) Address(number and street)
py,State,and ZIP Code City,State,and ZIP Code
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Country Country
Email Address Telephone Number Email Address Telephone Number
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Under penalties of perjury,I hereby certify 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
Sig lure oSel er Signature of Seller dot),
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Printed Name of Seller Date Signed(mm/dd/yyyy) Printed Name of Seller A igned(mm/dd/yyyy)
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J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDAStyFY ALL THAT A Y
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as i ars on cor1 'ay�ggGdocument
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Address(number and street) Address(number an e
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City,S te,and ZIP Code City,State,and ZIP Code 41.
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Country / Country
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Email Address
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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 YES NO CONDITION
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O 1.Will this property be the buyer's primary Er 3. Homestead
residence? 0 0 4. Solar Energy Heating or Cooling System
O O 2. Does the buyer have a homestead to be vacated 0 0 5.Wind Power Device
for this residence? If yes, provide address: 0 0 6. Hydroelectric Power Device
Address(number and street) 0 0 7. Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County 2.6
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