Homestead_Clem H. PREPARER
Preparer of the Sales Disclosure Form Title
Pamela Partenheimer Mick Attorney
Company
Address(number and street. city,state. country. and ZIP Code)
219 N Hart St, PO Box 13, 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
The Estate of Mary L. Goodman
Address(number and street) Address(number and street)
6462 W Old Princeton Road
City.state.and ZIP Code City,state.and ZIP Code
Owensville, IN, 47665
Country Country
gibson
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 Seller Signature of Seller
3 PAjP CR Gjovd AtL
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Patrick J.Goodman,Personal Representative 04/15/2024
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
Zachary M. Clem
Address(number and street) Address(number and street)
101 E Walnut St
City.state.and ZIP Code City,state,and ZIP Code
Owensville, IN, 47665 r21)
4,2
Country Country
gibson W N a
apply for certain deductions.Identify all of those that n : , o `0 ao
YES NO CONDITION YES NO CONDITION 1-ly1 Q Z
O O 1.Will this property be the buyer's primary O 0 3. Homestead m
residence? (2 C) 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 O 6. Hydroelectric Power Device
Address(number and street) O l] 7. Geothermal Energy Heating or Cooling Device
City.state,ZIP code,and county
1.4,•/7-412--. 04-- COO. 2 3g - 2_.
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
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