Homestead_Carner •
H. P EPARER
Prepar r of the Sales Disclos re Form
Title
Compy
__ _ --‘ - 1 111 L(----i ;, ---7 0 ,
I. SEILLER(S)/GRANTOR(S)
Sell — Name as it a pears conveyance document
‘4....ct._
Seller 2 — Name as appears on conveyance document
Add (number n street)
r-til MaLLV\ Sf
Address (number and street) i
Ci %Fite, and ZIP Code _
City, State, and ZIP Code •�`' t o C-- t- I f'J -C,`l 0 �UbiP Ftir�
Country r, Country ct Co i kip F���
c
r ay°f Pp ce '��L
prepared in accordance with IC 6-1.1-5.5. A person who knowingly and intentional( fat l,00transe tas
ransferred
real property, or o Its or falsifies any information required to be provided, commits a Level 5 felony. y _ sloes , j'of transferred
Signat re of Seller \
Signature of Seller G
......s.:
Printe• Name of Seller
I Date Signed (mm/dd/ y) Printed Name of Seller
les�� Irld� DateTtd (mm/dd/yyyy)
• ! C
J. B ER(S)/GRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY
Buye f — Name as It appears n conveyance document j L THAT APPLY
�,�� i �1� I Buyer_2 Name as it appears on conve ent
�, - I l ) \e Car oar—
D r--
Addre mber and street) I�-�
� � Addre s (nu er and streetLo0 : cab o
Ci S
State, and ZIP Code
1 �l 1 L !�, C ty, State, and ZIP Code
( � a C� 1 ICJ fl 01 rActeA n ` 4i00Coun / �n
Country �S
YES NO CONDITION
O 1. Will this property be the buyer's primary yc----- O 3. Homestead
residence?
0 0 4. Solar Energy Heating or Cooling System
0
Does the buyer have a homestead to be vacated ❑ 0 5. Wind Power Device
for this residence? If yes, provide address: O O 6. Hydroelectric Power Device
Addret...2.
ber and street)
i 0 0 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County
II
3 g
Underenaltles of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct,
as required by law, and is prepared In
-10 .
1