Homestead_Hillyard (2) 1
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Prepare. of the s Disclosure 9rtt� Title - -- --
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Company Email Address 1
Address(number and street, city,state, country,and ZIP Code)
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I. SELLERS)/GRANTOR(S) 1
Selle 1 -Name as it a Pars on,conve ante document S ller 2-Name as
>, PP Y appears on c^o2veyance d current
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Address(number and street) Address (number and street)
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pity,State,and IP Code City,State,and ZI Code
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Country I Country
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Under p nalties f perjury,I hereby certify 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 'n• •.d:r'te t' i ies a va .e ,J•f erred
z real property,or omits or falsifies any information required to be provided, corn its � • t
Signal of Seller i Signatur f II
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Printed Name of Seller '� Date Signed (mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
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J. BUYER(S)/GRANTEE(S) —APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIF L�. L •T APPLY
Buyer -Name as it appears o conveyanc document Buyer 2-Name as it appears on con eya/e '.cum
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Address number and street) Address (number and street)
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Ci ,State, and ZIP Code City, State,and ZIP Code zQ ,
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Country Country AUNT✓�
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Email Address Address Telephe Number
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION 1
U O 1.Will this property be the buyer's primary El- O 3. Homestead
U residence? O Lf 4.Solar Energy Heating or Cooling System
O Cf 2. Does the buyer have a homestead to be vacated O Q- 5.Wind Power Device I
for this residence? If yes, provide address: O G' 6. Hydroelectric Power Device
Address(number and street) O [f 7. Geothermal Energy Heating or Cooling Device
City,State, and ZIP Code County ,/-62-47- 443 /DU,3' 3 36-ozg
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 only if a Homestead Deduction is being filed.)
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