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PREPARER _ _ • -- - - _- - -.
Preparer of the Sales Disclosure For n T i Title - - --
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Company
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1 I. SELLER S /GRATO - -1144,
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( } R(S)
______
' Seller 1 - Name as it appears on ccnveyance document r -PP Y Seller 2 - Name as appears on conveyance document
Matt, A.
Address (number and street) Address (number and street)
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City, State, and ZIP Code i City, State, and ZIP Code _ -'
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Country 1rCL$ \(, L .
Count ry
best of my knowledge and belief, is 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 Seller .- Signature of Seller
Printed Name of Seller Date Signed (mm/ddlyyyy) Printed Name of Seller I Date Signed (mm/dd/yyyy)
_ - _. • 1 { I ,- 1o�. ________ :_ _
J. BUYER(S)/GRANTEE(S) - A LICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY HAT APPLY
; _______
Buyer 1l- Name as it appears on conveyance document Buyer 2 - Name as it appears on con eya e current
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Address (number and street) Address (number and street) n
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City, State, and ZIP Code City, State, and ZIP Co
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Country Country °4"
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D 3. Homestead
residence? 0 2 4. Solar Energy Heating or Cooling System
0 Q 5. Wind Power Device
., � O 2. Does the buyer have a homestead to be vacated �:
for this residence? if yes, provide address: 0 2' 6. Hydroelectric Power Device
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Address (number.and street) 0 8 7. Geothermal Energy Heating or Cooling Device
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City, State, and ZIP Code County "
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Under penalties of perjury, I hereby certify that 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 6-1 .1-5.5. A person who knowingly and intentionally falsifies the value of