Homestead_McDaniel H. PREPARER
� ---Preparer of the Sales Disclosure Form Title
Coordinator
llllOrlilCa SIYrikTelephone nurn5er
company
In Rern RED Services, inc. _ � - -
Add�re Ss Thumbetand street, city, slate, country, and ZIP Ccje.i
3447 N. Lincoln Ave.,Chicago, IL 60657
I. SELLER(S)/GRANTOR(S) Name as app 2 Soifer - nveyartce document
Seller 1 - Name as it appears on conveyance document `
Mortgage Guaranty Insurance Corporation Address (number and street)
Address (number and street)
,270 East Kilbourn Avenuet
City, state, end ZIP Cod��n
City, state, and ZIP Godc (/J ii,, / r ,
•Milwaukee, WI 53202 U ��
Country
Country
C act and complete as
u I herby certify this Sales Disclosure, to the bast of my knowledge an
Under penalties v1 perjury, the value of transferred
required by law, and is prepared in accordance with IC 6-1.1.5.5.A person wtw knowinglY and intentions —
real property, or omits ' tee any information required to be provided,commits a Level 5 felony. _
Si ature i Seer Signature of Setter
/ —er Se' ind ( 1-Date signed (rnmlddl;�Yy'Y)
Date sgemgrldd/yyyy) Printed Name of Seller
Prntsd Name f
J. BUYER S GRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL THAT APPLY
Buy 2-Name as it a ors a r!veyance pcument
Buyer 1 - Name it ears. on rnreyance document J -L.fAh —
C lQ stne'
�
Address (numb an !reef) Address (n�ber an 4V---i fY\ fly__ 42,.1 _ Gh-e--?!Yl 47stafld ZIP Code L 1
t , state, and ZIP Code I krT
"'�' (i/e,t______1
.1i:11Le-fr_li 4L- 1- -IL--1 2"0.,nisy i Country
_istE-'ta,
I T®` 0 3, Homestead
1. Will this property be the buyer's primary
1. ❑ residence? Q 4. Solar Ererry Heating or Cooling System
J ❑ A. 5. Wind Power Device
2. Does the buyer have a ho nestead to be vacated
for this residence? If yes, provide address: I ❑ p- 6. Hydroelectric Power Device I
A147) r1u and streetZit 0 7. Geothermal Energy Heating or Cooling Device
1
pit atete, ZIP a.•e, and unty ., I Z�^� —0 L _
r tjuAk* iktriew n �1 Li ) , 76 .. 1_1 —3 i —3� - 004 .
Under penalties of perjury, here y certi. that this Sales Disclosure, to he be of my knowledge
and 4<zaeiy r true, co;�e valueect complete
o pletc
as required by law, and is prepared in accordance with IC 6 1. ,-5.5.A personintentionally
o Fally .fa (Mote: Both et
transferred real property, or omi''tb or fetsit'es arty information required to be provided, commits
information, SSN/Driver's License/ID/Other Number is necessary If a Homestead Deduction is boIng filed)
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