Homestead_JorgensenSDFID:
Steven L. Whitehead Attorney
, Heparuo/NeSalaDittlosureFOrm Ttle
� Addres(NumberondStreet)
Princeton, IN 47670
Ciry, SmtG and LPCade
Nelsen JorQensen
SvJlu 1- Name ar appean on ronveyvnre davment
1824 N. Old Petersbure Road
Addras (NUm6er and Streef)
Princeton, IN 47670
liry, Smre, andLPlode
Name as appears om m�veyance dacumm[
Address (Number ond Sveey
[iry, Srure, andTJPCode
�
TelephoneNUmber E-mail I TelephaneNumber E-mail
Under penalties of erjury, I hereby certify tha[ [his Sales Disclosure, to the best of my knowledge and belief, is true, correct
a pl e re uir y law, and is p pared in accordance with IC 6-1.1-S.S, "Real Proper[y Sales Disclosure Act".
5(qn mreo Sel/er SgnoNreofSeller
Nels rge s 06-08-2011
Prin[edNam SfpnDute NH/DD RintedNameo Sef/er S'pnDote(H/4/OD
F.= R S GRANTEE S;-APPLICAT �FOR`PROPERTYTAX•DEDU - TIPY.ALL' TrAPPLY, -
Nelsen Jor ensen Donna Rae Jor ensen
Buyer]-Nameasappeorsonronveyancedxument � Buyer2-Nameasappeorsonconveyanredocumenr
. � 1824 N. Old Pet ure Road 1824 N. Old Pet oad
and7JPCode _
Princeton, IN 47670
City. Smte, and7JPCode
TNE S1LF5 DISCLOSURE FOILN MAY BE USED TO APPLY FOR CERTAI.4 DEpl16PIGk$ FOR TNIS PkOPER7Y. IOEhT1LY ALL OF TTtP361'HAT APPLY.
XQ � 1. Will this property be [he buyf
residence? Provide wmple[e
residence,including county:
Address (Nvmber ond StreetJ
Ciry, Stute 9PCode Counry
❑ XQ 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated,
including county:
Addras (NUmbrr ond StreerJ
Counry
X❑ ❑ 3. Homestead
� n 4. Solar Ener tlng/Cooling System
� Q 5. Wind Power Device
❑ Q 6. Hydroelectric Power Device
❑ Q 7. Geothermal Energy Heating/Cooling Device
� Q 8. Is [his property a residentlal rental proper[y?
� Q 9. Would you like to receive tax statements for this
property via e-mail? (Provide contoct information
below. Please see instructions/or more in%rmadon.
Not availa6le i all roundes.)
� -� ,,�/. 40- d�/.Qao - 0�7
PtlmaryOrocerNOwnerton[ac[name E-mail
Under penalties of perjury, t hereby certify tha[ this Sales Disclosure, [o the best of my knowledge and belief, is true, correct
and comple[e as required by law, and is prepared in accordance with IC 64.1•5.5, "Real Property Sales Disclosure Act". (Note:
Spouse y{formaty�a; Sesi�l S�enrity and Dryer's License/Other numbers are not necessary if no Homestead Deduction is
'Prin[MLegalNOmeo/8uyerl 5lgnDate[MH/DD/YYI'Yf PrinteeLegalNomeo(9uyu2/Spause
LastSdigiGSO(BuyerlDriver's Smre LastSDigiaoj5ocia15ecurityNum6er LastSdigi[sofBuyer2/SpouseDriver's Smte LastSDigicso/Social5ecunry
License/ID/OtherNum6er Num6er License/ID/OtherNum6er