Homestead_Coste H. PREPARER
Preparer of the Sales Disclosure Form Title
Sandra L. Hicks Attorney
Company
Address(number and street,city,state,country,and ZIP Code)
843 S. 9th Avenue, Haubstadt, IN 47639
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Mary Louise Martin
Address(number and street) Address(number and street)
500 N. Main Street
City,State,and ZIP Code City,State,and ZIP Code
Fort Branch, IN 47648
Country Country
USA-Gibson County, Indiana
Email Address
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.
Signature of Seller (L��j .t Signature of Seller
�6'4. ✓l [µ
Printed Name/Seller Date Signe (mrn/dd/yyyy) Printed Name of Seller 41Si ed(mm/dd/yyyy)
Mary Louise Martin ( - Q 2 6- 9"
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS— TIFY A4THA
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as it app conveyancetd ument
Stephen M. Coste Carlene M. Convis `ro �4 v
Address(number and street) Address(number and street) c'o c . �Cfl
101 S.Third Avenue 101 S. Third Avenue G'�j'y
City,State,and ZIP Code City,State,and ZIP Code 9G
Haubstadt, IN 47639 Haubstadt, IN 47639 ��To
Country Country 'Q
USA-Gibson County, Indiana USA-Gibson County, Indiana
Email Address
for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
O O 1.Will this property be the buyer's primary O 0 3. Homestead
residence? O O 4. Solar Energy Heating or Cooling System
0 0 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 _ r SQ °CO ` v 6/
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