Homestead_Dilbeck H. PREPARER
Preparer of the Sales Disclosure Form Title
Claire Kincaid
Address(number and street,city,state,country,and ZIP Code)
4799 Rosebud Ln., Newburgh, IN 47630
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Jeff Riffert Jay Riffert
Address(number and street) Address(number and street)
912 Warren Crossing P.O. Box 272
City,state,and ZIP Code City,state,and ZIP Code
Coppell,TX 75019 Haubstadt, IN 47639
Country Country
USA USA
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.
Signature o Seller • Signature of Seller
tom¢ �+�-
(4.44.4tiv,.
. "iy "Nam Seller Da red(mm/ . P me ame eller V Date ' 'ed m d/ )
By:Jana(Riffert)Kinney His AIF �� By:Jana(Riffert)Kinney His AIF
J. BUYER(S)IGRANTEE(S)-APPUCATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT APPLY
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as it appears conveyance document
Logan J.Dilbeck
Address(number and street) Address(number and street) I
9681 W.400 S. _
. City,state,and ZIP Code City,state,and ZIP Code
Owensville,IN 47665 JON
LI
N USA Country
USAntry 'Y ?5 40 2i
0
for certain deductions Atffyl ose that apply:
YES NO CONDITION Y S NO CONDITION 4/7-0R
0. 1.Will this property be the buyer's primary 0 3. Homestead
❑ residence? El 4.Solar Energy Heating or Cooling System
0 _
0 ® 2.Does the buyer have a homestead to be vacs ed El 0 5.Wind Power Device
I for this residence? If yes,provide address: ❑ 0 6.Hydroelectric Power Device
fr. A ress(numbgrand street) c ❑ 0 7.Geothermal Energy Heating or Cooling Device
Q 30d8�5�IIII St 306 J St.(JD n6At
t lN1 City,stak�ee code,and county \ 1 e Q n 'l 6 3 339 - cod
N Owegr�ville, 47665 0 ��`` "J L i ^ 6 t o Z-Q 00.
I Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete
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