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H. PREPARER <br />Preparer of the Sales Disclosure Form <br />Title <br />Erin McGuire <br />Survey Technician <br />Company <br />Email Address <br />Telephone Number <br />Lawson -Fisher Associates P.C. <br />emcguire@lawson-fisher.com <br />(574 ) 234-3167 <br />Address (number and street, city, state, country, and ZIP Code) <br />525 West Washington Avenue, South Bend, IN, USA 46601 <br />I. SELLER(S)/GRANTOR(S) <br />Seller 1 — Name as it appears on conveyance document <br />Seller 2 — Name as appears on conveyance document <br />Jenna Armington NKA Jenna Eberhart <br />Paulette Thibault <br />Address (number and street) <br />Address (number and street) <br />3502 Oakcrest Drive <br />3502 Oakcrest Drive <br />City, State, and ZIP Code <br />City, State, and ZIP Code <br />South Bend, IN 46615 <br />South Bend, IN 46615 <br />Country <br />Country <br />USA <br />USA <br />Email Address <br />Telephone Number <br />Email Address <br />Telephone Number <br />jaymckay03@yahoo.com <br />(574 ) 993-1230 <br />1 ( ) <br />Under penalties of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge and belief, is true, correct, and complete as <br />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 <br />real property, or omits or falsifies any information required to be provided, commits a Level 5 felony. <br />Si f ler <br />Signatur f eller <br />Printe ame of Seller <br />Date Signed (mm/dd/yyyy) <br />Pri d Na a of Sell <br />[� <br />Date Sig d (mm/dd/yyyy) <br />. V''.&V,dA E 9G"A (Z7 <br />/—z(D_Z <br />V <br />i <br />Z 6 Zr <br />J. BUYER(S)/GRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS — IDENTIFY ALL T AT A PLY <br />Buyer 1 — Name as it appears on conveyance document <br />Buyer 2 — Name as it appears on conveyance document <br />City of South Bend <br />Address (number and street) <br />Address (number and street) <br />227 West Jefferson Blvd. <br />City, State, and ZIP Code <br />City, State, and ZIP Code <br />South Bend, IN 46601 <br />Country <br />Country <br />USA <br />Email Address <br />Telephone Number <br />Email Address <br />Telephone Number <br />Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to apply for certain deductions. Identify all of those that apply: <br />YES NO CONDITION <br />YES NO CONDITION <br />O 0 1. Will this property be the buyer's primary <br />O O 3. Homestead <br />residence? <br />O Q 4. Solar Energy Heating or Cooling System <br />O O 5. Wind Power Device <br />2. Does the buyer have a homestead to be vacated <br />O O <br />for this residence? If yes, provide address: <br />O O 6. Hydroelectric Power Device <br />O 0 7. Geothermal Energy Heating or Cooling Device <br />Address (number and street) <br />City, State, and ZIP Code County <br />Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct, and complete <br />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 <br />transferred real property, or omits or falsifies any information required to be provided, commits a Level 5 felony. (Note: Both spouse's <br />information, SSN/Driver's License/ID/Other Number is necessary only if a Homestead Deduction is being ruled.) <br />Si <br />re Buyer <br />Signature of Buyer 2/Spouse <br />Printed LTgSI N me of Buyer 1 Sign D to (MM/DD/YY) <br />Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY) <br />�L tzhc�1-i�cr� a <br />Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Num er <br />Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number <br />d1 <br />Page 3 <br />