HomeMy WebLinkAboutHomestead_Cummings H. PREPARER
Preparer of the Sales Disclosure Form(.: r- k . Title
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Company
Address(number and street,city,state,country,and ZIP Code)
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I.SELLER(s)/GRANT0R(s)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyan.:"•=. ument
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Address(number and street) Address(number and street) 4'
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City,„ate,and ZIP Code City,state,and ZIP Code
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Country Country /
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of my knowledge and belief,is•tr -09 .and complete as
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required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally fals15 )4 I e of transferred
real property,or omits or falsifies any Information required to be provided,commits a Level 5 felony. O.
gli a t u r e of Seller iii Signature of Seller
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ed Name of Seller -Tate signed(mm/ddlyyyy) Printed Name of Seller Date signed(mm(cid/yyyy)
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J. BUYER(S)IGRANTEE(S)-APPLICAT ON 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
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Address(number and street) Address(number and street)
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City,state,and ZIP Code City,state,and ZIP Code
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Country Country
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YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary Er 0 3.Homestead
SR 0 residence? 0 El 4.Solar Energy Heating or Cooling System
7,,, 2.Does the buyer have a homestead to be vacated 0 .ciT 5.Wind Power Device
0 '''-'4 for this residence? If yes,provide address: 0 Z 6.Hydroelectric Power Device
Address(number and street) 0 Er 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county 2-6—1-7--Zet—40 Q-0 oti. ra_a-o-LI
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
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