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I�DIANA SAL£S DISCLOSURE FORM SDF ID: ea�
D.PR�PARER _ . , . _ _ • .
IJenm Sherrill Cusiomer Service R_oresentative �'
%eparer of �h• Sales Dkdosure Form Title
�025 E. 82nd Street Suite 110 Statewide Tiile Comoany. Inc.
ddaress (Number and Smee[J Compam�
IIndianaoolis IN 40"250
Fadaral Hmm= I nan MMgagP rmm�ratinn
Seller 1- Name as apoean on convevonce dacvmm:
5000 Plano ?arkwav
AEdress (Nom6er and SneeQ
Carmllinn TX7501(1
Ciry. Stare, and Z/P Code
Seller? - Name as appeva an cam�e�vnce dovment
Ado�ess (Number and 5[reet)
Cin, Smte
Under Ities of perjurv, I here6y cer[ify that this Sales Disclosure, to the bes[ of my knowledge and belief, is true, correct
and ompl as required by law, and is prepared in accordance �vith IC 6-1.1-S.S, "Real Properh� Sales Disclosure 9ct".
SianamreoJ5e1ler � �1 _ � SionamrrofSelfer
r � � 1 `.'l. v � �
v.ar If-�Name et appea(rs� on ronve�vnc_ docv(m�en:
_~ r • \��N ��i_� h ,�
A�(ress (A'um6er and S�eec)
Ilr tn�c�iov� �-�..i �1�(n � o
Gry�, Smce, ond2lP Lode
THE SALES DISCLOSURE FORM MA}' gE USEO TO APPLI' FOR CE0.TAI9
Adcres/NumberandStreenJ �
PrrN�e{r„n .�-n, `f71�7a
City.
�_�. �. ,.....,
FORTHISPROPERTy, IDE\TIFI'dLLOF
� � 1. Will this property be the buyer's primary
residence? Provide complete address of prim
residence, indudin� counq�:
f�l 9 C. (J,�.. �q � (5 r
�d¢•ecs,(�YUmberanC�SVeet) 1 `,1 6 0
{�'4>C Y .7M cc �.. Tp/ Y % �•iJj,fe /�
�"
C j�, sm[e zl? Cace eoung
IY I � 2. Does the buyer have a homestead in Indiana to be
7-`� vacated for this residence? If yes, provide
complete address of residence being vapted,
including counrv:
Sf?Y3 S. iaso l�
Address (M1Umberand Svee�)
Qo.�enS�tlle �',n� [f76GS C�',\���
[iq. Sm[e ZIPCode CounN
� 3. Homes[ead
� 4. Solar eann�/Coolin� System
I1C1 5. Wind Power Device
� � 6. Hydroelectric Power Device
❑ 7. Geothermal Enere � HeaGng/Cooling Device
� � 8. Is this propertv z residen[ial renUl property?
❑ � 9. \Nould you Iike to receive ta� statements for this
property via e-mail? (Provide contot[ lnformotion
below. Please see instrucdons%ar more informatian.
Not available in all toundes.)
a �-05-3 3-ioa -�3. `�53�7
Pdmarv oro�em• awne� ronmtt name E-mail
Under penalties of perjury, I hereby certifi� that this Sales Disclosure, [o the best of my knowledge and belief, is true, correc[
and comple[e as required by la�+�, and is prepared in accordance with IC 6-11-S.S, "Real Propem� Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/O[her numbers are not necessary if no Homestead Deduction is
being f led.)
. . . _ ,. _ _ �. .
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