Homestead_Trust H. PREPARER - -
Preparer of the Sales Disclosure Form —
Sandra L. Hicks
Title
Attorney
Company
j
' Address (number and street. city, state. country, and ZIP Code)
! 843 S. 9th Avenue, Haubstadt, IN 47639
I. SELLERS)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document , Seller 2 - Name as appears on conveyance document
Carol Sue Birch
Address (number and street) Address (number and street) 1
3284 W 50 S 1
City. State. and ZIP Code City, State, and ZIP Code
Princeton, IN 47670
Country Country
Gibson County - USA
Email Address
( )
Under penalties of perjury, I hereby certify 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 transferred
real property, or omits or falsifies any information required to be provided, commits a Level 5 felony.
Signature of Sell )(tize_elae Signature of Seller
1 (224.11t-
Printed Name of Seller r Date Si ned ( idd/yyyy) Pnnted Name of Seller Date Signed (mm/ddlyyyy)
Carol Sue Birch 1 2 / s_ ZOZc
J. BUYER(S)/GRANTEE(S) - APPLICATION F R PROPERTY TAX DEDUCTIONS - IDENTIFY ALL THAT APPLY
Buyer 1 - Name as it appears on conveyance document r Buyer 2 - Name as it appears on conveyance document
The Ralph E. Day and Dorothy Jean Day Revocable Living Trust of 11/1 018
Address (number and street) Address (number a ee
5503 CR 3810
City. Slate, and ZIP Code City, State, and ZIP Code = _ ,I
West Plains, MO 65775 ' 1) i
Country Country 144/ 2
I
-
Howell County USA / ? 9
Email Address
apply for certal o�t�,,1de fy all of those that apply:
' YES NO CONDITION YES NO CON6ifI `
1
1. Will this property be the buyer's primary '' ❑ 3. Homeste'
y QR
0 ❑ residence? ❑ 0 4. Solar Energy Heating or Cooling System
❑ ❑ 2. Does the buyer have a homestead to be vacated ❑ El 5. Wind Power Device
for this residence? if yes, provide address: El 0 6. Hydroelectnc Power Device II
11
Address (number and street) ❑ 0 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County
342 - 1\ — c -- ( Q Q - ao c1_, -- CI,
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
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CT - ( 232 .