Homestead_Umpleby (2) _ - -
H. PREPARER
Preparer of the Sales Disclosure Form Title ,
Daphne Kramer Paralegal
Company
Address(number and street,city,state,country,and ZIP Code)
120 S Main Street, Princeton, IN 47670
I. SELLER(S)/GRANTOR(S) •
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Billie Hartley
Address(number and street) Address(number and street)
2955 E SR 65
City,State,and ZIP Code City,State,and ZIP Code
Hazelton, IN 47640
Country Country
USA
Email Address
best of my knowledge a el* ," true,correct,and complete as
required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly an tent n fal "fies the value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felon
riwZe of Seller Signature of Seller
'144/ .1)
Printed Name of Seller :at4Aigned mm/dd/yyyy) Printed Name of Seller 22 9, Date Signed(mm/dd/yyyy)
Billie Hartley 12 oftove cua
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEIctitt IDENTIFY ALL THAT APPLY
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as it Pz9 Q5.0<lveyance document
Danny R. Umpleby
40„ _
Address(number and street) Address(number and street) '47'04
426 N Spring Street
City,State,and ZIP Code City,State,and ZIP Code
Princeton, IN 47670
Country Country
USA
Email Address
for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
s
1.Will this property be the buyer's primary 0 0 3.Homestead
2 0
residence? 0 0 4.Solar Energy Heating%!A:
2.Does the buyer have a homestead to be vacated 0 2 5.Wind Power Device
0 0 for this residence? If yes,provide address: 0 2 6. Hydroelectric Power Device
Address(number and street) (:) 7.Geothermal Energy Heating or-Cooling aevice
2036 W 450 N
City,State,and ZIP Code County
Patoka, IN 47666 D„f,- LI-IL-20(i c.1 2 3c y- _
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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