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_:'E E I VED r ir= - i3aDARFJ CiF <br />I �CJUMFNT# <br />'y 1.3157 <br />DE�.CR I PT I ON <br />DE-n <br />SUPPLEMENTAL <br />'4 <br />DATE: <br />RECE ED ROA <br />L ADD 55: <br />F6R: <br />ACCOUNT <br />Amt. of Acct. <br />LAid <br />!SR" 8L804 <br />r <br />HOW PAID <br />ash <br />Check <br />Money <br />Order <br />T• Jrj CCLNTY F'ECc-Fr'E-, <br />T-r, EF.'SC?N AVE�Nl-iE <br />'=r11'TH --ENE?.=i�IpIAM1IA /iF �l� j <br />TOTAL <br />RECEIPT �,Il•iriP,.EP: 1.3;C; <br />1?E(--E :PT DeATc . 3/2/.,/ <br />r',E D HCc t--F p AY : <br />AMC0Nl T <br />7. Co <br />z rm <br />PAGE: I <br />APF'R('1VF_'D eY THE rt1:'1AFr') r)F A,''(-I"ON T S P� IF1 S'r. JOSEPH COUNTY, ] 9q,3 <br />date of sale <br />❑ Current Property Record Card Attached AV Improvement(s): $ <br />Property Class !Use Code: AV Total: $ <br />Part 4 - Signature <br />IF <br />parties to a real property conveyance are required to file •this form and attest in writing and under the penalties of perjury that the information contained <br />' ein is trueand correct. A person who knowingly and intentionally falsifies or omits any information required on this form commits a Class A infraction. <br />er Penalties of Perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, Is true, correct and complete <br />equired by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". <br />