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Homestead_Benton
H. PREPARER Preparer of the Sales Disclos Fonnl Title . __ J"V� c IN, C7C7 c Company • ]22L15 C. ( 00 St t � / l/Q c. � �,AI✓, 4 '7666 I. SELLERS)/GRANTOR(S) • Seller 1-Na a as it a pears on conveyance document Seller 2-Name as appears on conveyance document' Cir Address(number street Address(number and street) . l �v a2L(5 Et 100 Si City,State,and ZIP Code 1 City,State,and ZIP Code (21L 1 Acd �.1-n flit) i'7060 , Country 5 A .. . • Country t. .;t. ': t.).!F.' t•• r'a -' ,. .14 libfeby certify this Sales Disclosure,to the best of myknowledge and belie is g f, 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. Signature of Se r d Signature of Seller Printe Name o Seller A r P „ct ` ��red(mmldd/yyyy) Printed Name of Seller Date Signed(mm/dd! . ) : ,_,.?� t) J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY T • -PLY Buyer 1 � 6s me ppQars qanpe docume Buyer 2-Name as it appearsi �� nce eya t.! // / 4 � Q 1./ I �' Address(number and Wet) �� Address(numb=r:�SO bet) ?©�� ,- 3 r cry API City State,and ZIP ode City,State,and ZIP Co• de�p c ' C .G.. �itel. 764 d Code -` . nri -i--) Country /, ( S Country ''IO 9 Email Address ,_ ( ) Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to app for certain deductions.Identify all of those that apply: YES NO CONDITION Y NO CONDITION �❑ 1.Will this property be the'buyer's primary , 3.Homestead lresidence? ❑ 4.Solar Energy Heating or Cooling System ❑ [41 2.Does the buyer have a homestead to be vacated ❑ 5.Wind Power Device 444JJJ for this residence?If yes,provide address: a 6.Hydroelectric Power Device ..! Address(number and street) [I 7.Geothermal Energy Heating or Cooling Device • City,State,and ZIP Code County Z\ -I Lk -I -`-A0- -coo -SUA-00( • , gy p,,x�'' y Q :,�'r •f by'