Homestead_Jones (11) H. PREPARER
Preparer of the Sales Disclosure Form Title
J. David Roel den Attorney
Address (number and street, city, state, country, and ZIP Code)
801 Busseron Street, P.O. Box 215, Vincennes, 1N 47591
I. SELLER(S)fGRANTOR(S) — ---
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Rodney W. Jones Lisa M. Jones
Address (number and street) Address (number and street)
gOW. 800S., Apt. 5204
11534 S. 150 W.
City, State, and ZIP Code City, State, and ZIP Code
Fort Branch, IN 47648 Haubstadt, 1N 47639
' Country Ccuntry
USA USA
Email Address
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.
j Signature of Seller Siinatue of Seder ,'" \
Printed Name of Selle r Date Signed (nim'ddlyyyy) I Printed Name of Seller Date Signed (mmidtliyyyy)
Rodney W. Jones 1 fl/(9 2 5 : Lisa M. Jones I C-/S7' 4R6 25
J. BUYER(S)IGRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL THAT APPLY
Buyer 1 - Name as it appears on conveyance document Buyer 2- Name as it appears on conveyance document
Lisa M. Jones
Address (number and street) Address (number and street)
11534 S. 150 W. ,
City. State, and ZIP Code City, State. and ZIP Code
Haubstadt, IN 47639 -_--
Country Count/
USA _ — A - -
Email Address Address O e e• . =i Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to apply for certa ' ns. Identify al se that apply:
YES NO CONDITION— DYES NO C
1. Will this property be the buyer's primary Ni ; 1 3. Horn
residence? 0 4. Solar Fne r Cooling System
0 fa 2. Does the buyer have a homestead to be vacated ' ' S. Wind Power Devi1j��
7 for this residence? If yes, provide address: 0 X 6. Hydroelectric Power Oe 'ice
Address (number and street) 0 Ect 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County 4 ‘ 22.-12 - Jo + - 0 0 2 ' 123 -02'i ,
Under penalties of perjury, l 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.S A person who knowingly and Intentionally falsifies the value of
transferred real property, or omits or falsifies arty Information required to be provided, commits a Level 5 Felony- (Note: Both spouse's
information, SSN/Driver's License/ID/Other Number is necessary only if a Homestead Deduction is being fled.; - , -
Signature+ of Buyer 1 f Ni l(?--'f-�U,(ii;IS. Signature o'Buyer 2iSpouse
,
Printed Legal ame of)l/er i Sign Date (MM/OD/YY) Printed Legal Name of Buyer 2/Spouse Sign Date (MMJDU/YY)
Lisa M. Jones -
fLast 5 Digits of Buyer 1 SSN/Oriver's License/ID/Other Number Last 5 Digits of Buyer 2/Spouse SSNIDiver's LicenscitOiOther Number
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