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Homestead_Rybachek
H. PREPARER Preparer of the Sales Disclosure Form Title Renee R. Black Attorney Company Address(number and street,city,state,country,and ZIP Code) • 2803 W. Broadway Street, Princeton, Indiana 47670 fi I. SELLER(S)IGRANTOR(S) Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document Lloyd Parker Becky L. Parker Address(number end street) Address(number and street) 7766 W. 600 S. 7766 W. 600 S. City,State,and ZIP Code City,State,and ZIP Code Owensville, Indiana 47665 Owensville, Indiana 47665 Country Country USA USA Email Address Under penalties of 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 5.1.14.5.A person who knowingly and intentionally falsifies the value of transferred I real property,or omits or falsifies any Information required to be provided,commits a Level 5 felony. Signature of eller Sig eture of Seller ' Printed Name-of Seller Date Sinned fmm/dd/yyyy) Printed N AI e of Seller I Date igned(mmld yyy) Lloyd Parker . 60 //.3 ..'t7;.?.5 Becky L. Parker Z /' ;,____ J. BUYER(S)IGRANTEE(S)—APPLICATION 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' Kelly J. Rybachek 1 Address(number and street) Address(number and street i 5658 S. State Road 165 City,Slate,and ZIP Code City,State,and ZIP Code Owensville, Indiana 47665 tikb Country Countryp I�FA USA a /y Email Address apply for certain dif r'. Yttify I of those that apply: YES NO CONDITION YES NO CONDITI /i/n, 1,Will this property be the buyer's primary O 0 3. Homestead 'qU© 1 © D residence? D ❑ 4.Solar Energy Heating or Cooling System 0 O 2.Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device for this residence?If yes,provide address: D p 6. Hydroelectric Power Device Address(number and street) D O 7. Geothermal Energy Heating or Cooling Device City,State,and ZIP Code County Oh Kb.- if _ 09-2.0O - 0 0o.,Q4- _0 21 '-4., ,� I CP 3 u 6