Homestead_Skelton (6) H. PREPARER
Preparer of the Sales Disclosure Form Title
Daniel L.Siewers Attorney
Company
Address(number and street,city,state, country,and ZIP Code)
513 Main Street,Vincennes, Indiana 47591
I. SELLER(S)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Terri L. Mans Brenda L. Rudolph
Address(number and street) Address(number and street)
1803 Cambridge Pl. 146 S Springfield Dr.
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670 North East, MD 21901
Country Country
E-mail address
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 informa5onliquired to be provided,commits a Level 5 felony.
Signal e/o Signature of Seller
L '
74Printed Name of Seller Date signed(mm/ddlyyyy) Printed Name of Seller Date igned(mm/dd/yyyy)
Terri L. Mans CAP 103 /aDat-i- Brenda L. Rudolph
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
Barbara J.Skelton
Address(number and street) Address(number and street)
b'oet;ip:0024-neze4naj AUDITOR b aj
910 S Hall St.
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670
Country Country
E-mail address
apply for certain deductions.IdG*...,u3S0aPhose trpply:
YES NO CONDITION YES NO CONDITION
D 1.Will this property be the buyer's primary El 3. Homestead
residence? Ei 4. Solar Energy Heating or Cooling System
o 2. Does the buyer have a homestead to be vacated 0 El 5.Wind Power Device
El for this residence? If yes, provide address: 1:1 1=l 6. Hydroelectric Power Device
Address(number and street) o El 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
2 Zol -18-ID
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
transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
information,SSN/Driver's License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
SigVure ofi /9/ j Signature of Buyer 2/Spouse
Printed Legal Name f' 'uyer 1 Sign Date(MM/DD/YY) Printed Legal Name of Buyer 2/Spouse Sign Date(MM/DD/YY)
Barbara J. Skelton blp I v3
iaLI-
Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
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