Homestead_HartleyINDIANA SALES DISCLOSURE FORM SDF ID: F�a e 2
D.PREPARER �
Jerty'�!;ttomey at tihvell Attomey at Law
�epnrer o(Ne Salu Disdasvre Fonn Title
N. Prince SUeet Bamberger, Foreman, Oswald & Hahn, LLP
Address(Num6erandSheeQ
Number E�mail
E. SELLER S GRANTOR S � � � � � � ' � � • ' � � " � � � �
Gary HarUey
Se/ler ]- Name os appeon o^ romeyance darument Se11er7 � Name as appears on ronveyanre dxumen[
9N Bee�eaterPlace
Addrecs (Numbo and StreetJ Addless (Number ondStrmlJ
N. Las Veaas, NV 89032
Tele honeNUmber E-mail Tele honeNum6er E-mail
Under penalties of perjury, 1 hereby certify that this Sales Disclosure, [o [he best of my knowledge and belief, is true, correc[
and comple[e as requir d by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
.�.__ �. �,�.:,�
Signo � oJSeller Signomreo(Seller
GARYHA.RTLEY /Jec 30 2o1I
Rlnred ' Si nDOft MM DD Rin[¢dNomeo Seller $i nDuf4 N.v/DO
YER S GRANTE S- APPLICATION FOR PROPERTY TAX D TIFY ALL ITEDIS�THAT APPLY
George R. Hartley Marta Hartley
]�A'ameasa ^ mnveyancedocummt , appearsanconvryonmdacumen[
7040 N. Old U.S. Highway 41 7000 N. Old U.S. Highway 41
Address (hbmber and SveetJ Addrtss (Number and Svee[J
°nnceton,IN 47670 Pnnceton,IN 47670
Iry.Sm�e, and Z/PCOde
E'�muil Tele honeNumber � E�mail
THE SALFS DISCLOSURE FOM1 NA1' BE USED TO APPLI' FOR CERTAIY DEDUCf10N5 FOR THIS PROPERTY. IDEMIFY ALL OF THOSE THdT APPLY.
1'FS �0 CO\DITIOM1 5 �O COtiDIT10\
✓� � 1. Will [his property be [he buyer's primary � 3. Homes[ead
residence? Provide complete address of primary �j 4. Solar Energy Heating/Cooling Sys[em
residence, induding county:
7040 N. Old U.S. Hghway 41 ❑ ❑✓ �• W�nd Power Device
Address(NUmberandS[reetf ❑ ❑✓ 6. Hydroelectric Power Device
Princeron, IN 47670 Gibson � � 7, Geothermal Energy Hea[ing/Cooling Device
Ciry, Smte ZIPCode Counry
Q✓ � 2. Does the buyer have a homestead in Indiana to be
�J � 8. Is this property a residential ren[al property?
vacated for this residence? If yes, provide ❑ �✓ 9. Would you like ro receive tax statements for [his
complete address of residence being vacated, ' property via e-mail? (Provide contact information
induding counq,: - below. Pfease see instructions for more injormation.
6378 Blackbum Road Not avoiloble in all counties.)
Addrus (Num6er and StreetJ
Petersburg, IN 47567 Pike
Ciry, Smte 2IPCode Counry
� ln-=-I i-c� 1- I nn �60' 7�j � n��
Pnmarypmperryawnermnmrtname E-mail
UnAer penalties of perjury, I hereby certify [hat this Sales Disclosure, to the bes[ of my knowledge and belief, is [rue, correct
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure AcY'. (Note:
Spouse information, Social Security and Driver's License/O[her numbers are no[ necessary if no Homestead Deduction is
be' g filed.)
�!�� � ;►�ti� � ��(.�Y ���-
SignaNm uyu] Sign eofBy�er2/5 se
�ORGE R. HARTIEY � Z/3 �� 1 MARTA HARTLEY �,� /3v ��
�'nnredLegalNameofBvyer7 Sign ate(M OD/YYY17 Pnn[edLegalNameofBvyer2/Spouse Si�NM/DD/YYn7
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LastSdigiuo�euyer]Driver's Smte LastiDigiuof5ocial5eturityNumber LostSdigiuofBuyer2/SpouseDriver"s Sto[e LastSDigiao�5xial5ecuriry
Lirente/ID/OtherNumber Number License/ID/Otheri\'umber