Homestead_Renfro (2) H. PREPARER
— .
Preparer of the Sales Disclosure Form Title
Pamela Partenheimer Mick _Attorney
Company
Address(number and street,city,state,country,and ZIP Code)
•
219 N Hart St, PO Box 13, Princeton, IN 47670
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on con a c oc ent
Patrick A. Clark
Address(number and street) Address(number and street) s41)4
330 S Seminary St 4,044
t
City,state,and ZIP Code City,state,and ZIP Co q /LI
I/ 1
Princeton, IN 47670 Q _ egz.,
co
Country Country 04,
gibson
of my knowledge and belief,is tru itp,, ct and complete as
required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifie' the value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Signalu er Signature of Seller
Pri9id Name of Seller Date signed(mm/ddlyyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Patrick A. Clark 04112035
J. BUYER(S)/GRANTEE(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
John Robert Renfro
Address(number and street) Address(number and street)
330 S Seminary St
City,slate,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670
Country Country
gibson
-.
Pursuant to IC 6-1.Y-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
X ,./6-g
, 1.Will ti2j.s property be the buyer's primary
;r ridence? 0 0 3. Homestead
0 0 4.Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated 0 0 5.VVind Power Device
0 0 for this residence?If yes,provide address: • 0 0 6. Hydroelectric Power Device
Address(number and street) 0 CI 7.Geothermal Energy Heating or Cooling Device
City,slate.ZIP code,and county
(2-C-k2-- 01-(kQl -000.Z31—0 2,2 •
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