Homestead_Denham (3) .. ........ ... ... .. .... ....... . ... . ... ..,, . . . . ... . . ..
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Preparer of the Sales Disclosure Form Title .
Jerry A.Mason
Company .
Address(number and street,city,state,country,and ZIP Code)
726 N.Cherry Street,Mount Carmel,IL,USA,62863
(10.01:0*PP400(0:::...1*.',1.:::,.-:...:.:1:.::......:.': ''.:'::',::::•: '.-:.... ..: ::,'..:f:'.' .::. .:'• '''-'':'....' ::::':::::::-'......:.'.:-::::---:;:.'''''..,...' . :::' .:-.:..:':''..-,:•.*:','-:::-:
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Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Jerry A.Mason Roberta J.Mason
Address(number and street) . t Address(number and street).
726 N.Cherry St. 726 N.Cherry St.
City,State,and ZIP Code City,State,and ZIP Code
Mount Carmel,IL 62863 Mount Carmel,IL 62863
Country Country
USA • USA
.:
:sregirired'hYlaiii,“enctIS,PrePareel•jn:aocOrdanee Vrith•IC:04:1.14.5.A Person who knowingly and'Intentionally falsifies the value of transferred
leal.prOpeitir;or omits or falsifies any information required to be provided,coramitt'it.eVel 6 feloik.*;-....::::.1.---.' ,s':...: ,.-' .:. •**.!••:.'':::.:t..
Sig lure o ler- gn ur I rh+1 _
/4 -.-4-----
elif(in
in ed Name of Seller Date Signed m/dd/yyyy) Pn t ame of Seller , Date Signed(mm/dd/yyyy)
lel`ry 74-, initso..ki Oiloa ?-025- -VI • Seller
son 07/021/M95
-:-$:'•:ituyikwiGkki.E E(i). -APP1...1CAT- i0140sisk:Filiaiiiiti.tiii:DEDudfiONS,;:: • •• 0,i'ALLi4A-i Aii0Li.::"'....:
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as it app r o c veya ocument
Ebt,t4 Blake Dentm , r) ,
Address(number and street) Address(number and street)
608 S.Race St.
City,State,and ZIP Code Jilt n j n 2025
-
City,State,and ZIP Code cr
Princeton,IN 47670
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Country Country /17 , V I--- -,6.)--) i
USA . Gis.Q-, ---.-c.r ....--)
,-.1-115,1 r,,,:: Lor...... .00(
Email Address
apPly.for certairidediretions..IderitifilIftif those that aPply:-;:.1.:-
YES NO CONDITION YES NO CONDITION .
ri r-i 1.Will this property be the buyers primary do gr- 3.Homestead
" residence? El E3 4.Solar Energy Heating or Cooling System.
2.Does the buyer have a homestead to be vacated 0 51 5.Wind Power Device
13 - for this residence?If yes,provide address: 13 I2. 6.Hydroelectric Power Device
Address(number and street) El E2 7.Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code . County QUI-t. -cyrn t - Lk c)-- .e..)o0-1-Tor-C)a?
• .
Under penalties of lierjuty,:i ber,ebyscertjfkftfatitbia.Salet Discicistire;Ao:tife'beat of My knowledge and belief,is trire;*etirreeti.and complete2.:
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