Homestead_Mendenhall —---- - - -
li H. PREPARER
Preparer of the Sales Disclosure Form - r Title ______
Company Email Address
Address (number and street, city, state, country, and ZIP Code)
//7. l�/�s C v/eA.Z//01/o� �,V637-w f /47 (�5/- 1 r.6J_y _ _
� r�
I. SE TR-W)/GRANTOR(S) T
Seller 1 - Name as it appears on conveyance document
ll J t Seller 2 - Name as appears on cony ocument _ —
Address (numbeer/r and street) Address (number and street)
/. /7:5 1/1 -5 r eguiOIX ilk/ /-cc()
1 C;ty, State, and ZIP Code City, State, and ZIP Code `�q/1/
lfc e..1 a T IA' 1V7 3/ (:I )1
Country Country eq,
IED ,
004,
best of my knowledge and belief, is true, , 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 t value of transferred
1 real property, or omits or falsifies any information required to be provided, commits a Level 5 felony.
Sign e eller Signature of Seller
deZ
Printed Nam Of Sell Date Si (mm/dd/yyyy) Printed Name of Seller Date Signed (mm/dd/yyyy)
: /4/1//16/le/i1///(-76/72-W/Yga -1X1.- 00/ /-3/7-0Z6 ___ _____ _ ___
J. BUYER(S)/GRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS — IDENTIFY ALL THAT APPLY
Buyer 1 - Name a .1 appears n conveyance documentBuyer 2 - Name as it appears on conveyance document
Address (number nd stree`t) /hLLo&
T Address (number and street)
/4 3 51 r /1//� //U%..4t)Lc� / / �1 �5 Cff G���i9 ' d
City, State, and ZIP Code City, State, and ZIP Code
//. , r V76) jq � 4,n57;-7 r. /A/ A/T659
Country Country
. 1 .5/4 Z(J)
M CY 0 3. Homestead
2/ 0 1. Will this property be the buyer's primary
residence? 0 Er 4. Solar Energy Heating or Cooling System
,�.,l 2. Does the buyer have a homestead to be vacated 0 (3-- 5. Wind Power Device
0 `Id" for this residence? If yes, provide address: 0 [�' 6. Hydroelectric Power Device
Y
Address (number and street) 0 er 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County p /.
6 e 1%-36 -3ou --- 0 7 _ C 12_-02-ti
. 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
i transferred real property, or omits or falsifies any information required to be provided, commits a Level 5 felony. (Note: Both spouse's