Homestead_Cortez H. PREPARER
Preparer of the Saks Disclosure Form Title
Nathan McCain Trustee/Manager
Company
Address(number and street,city,state,country,and ZIP Code)
5424 McFarland Road Indianapolis,IN 46227
I. SELLER(S)/GRANTOR(S)
Seller I- Name as It appears on conveyance document Seller 2- Name as appears on conveyance document
816 South Gibson Street Land Trust
Address(number and street) Address(number and street)
5424 McFarland Road
City,state,and ZIP Code City,state,and ZIP Code
Indianapolis,IN 46227
Country USA Country
( )
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 pro erty,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Sign a Signature of Seller
Pr. Name of Seller I O d �1!� Printed Name of Seller I Date signed(mm/dd/yyyy)
Date signed(mm/dd/yyy
Nathan McCain �c 9(
)
J. BUYER(S)/GRANTEE(S)- APPLICATION FOR PROPERTY TAX DEDUCTIONS- IDENTI LL THAT APPLY
Buyer I-Name as it appears on conveyance document Buyer 2-Name as it appears on con c nt
Maria Berenice Sebastian Cortez
Address ,number and street) Address(number and street) J ,
907 S Seminary St, J
City,state,and ZIP Code City,state,and ZIP Code 0N /
Princeton,IN 47670 4024
Country USA Country USA G/Q-
E-mail address
q(/ /
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:R
YES NO CONDITION YES NO CONDITION
X 1. Will this property be the buyer's primary X 3.Homestead
residence? X 4.Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated X 5. Wind Power Device
for this residence?If yes,provide address: X 6.Hydroelectric Power Device
Address(number and street) X 7. Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County I ^I _(1p1 6_O2,3
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