Homestead_Long�\\A SALES DISCLOSURE FOR\1 SDF ID SDO ID 468131 Page Z
D:FREPARER
Samantha L Cutsinqer
Repore� l oj�he Sales D'udosure Form TiJe
226 W. Brtatlway Broadvrdy Title, Inc.
Addrm (A'umier aM SvittJ Campvny
Prince�on, IN 4767Q
Qry, Smce, mJ ZI➢CoCe Telephone Num6er E-mall
E.SELLER(SJJGRANTOR(S)
Dennis L Griggs
Seller ]� A'amr es appean om m�rqx�me Jaumem
1309 W. Broadway
Addrms(NumMrondSVeeQ
Princeton, IN a7670.
liry', Sm[e, andllPCode
a� t•f/A
Under penalties of perJury, 1
and�omolete as required t�y
2NN�5 �� �
Name as uppavn. w mnvevunw da'umen�
Addrtss (NUm6rr and Sve<t)
Ciry, Smte, nnAZ1P Cade
certify that this Sales Disclosure, to the bes[ of my knowledge and belief, is true, correct
d is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
6uyerl�RUmensvpya amm�veyvaw0avmen:
8 urch Rd.
Address (RUmber and Svrr�J
Princeton, IN 47670-
SALES DISCLOSURE FORM MAY BE USED TOAPPLY FOR
x� � 1. Will this properry be the buyer's prima� �
residence? Provide complete address of p'mary
residence, including counry:
831 S. WHITE CHURCH RD.
Addrca (A'umber and Snea)
Prince�on, IN 47670 GIBSON
Ciry, Smu ZIP Cade Counry
�� 2. Does the buyer have a homestead in Indiana m be
vacated for this residence? If yes, provide
complete address of residence being vacated,
induding counry:
Address (KUmber and 5[rret)
Ciry, Swre ZIP [ode Counry
Signamrrcf5cller
Buyer? � A'ame as apprors an ronveynnre document
Addras (Numbrr vnd Sveee�
Ciry. Smre, and ZIP CoEe
�PROPERTY.
Y'FS NO CO\OITIOY
�X � 3. Homestead
�3Ti. Heating/Cooling System
� Q 5. 6Vind Power Device
❑ Q 6. Hydroelectric Power Device
� Q 7. Geothermal Energy Heating/Cooling Device
� Q 8. Is this proper[y a residential rental property?
� Q 9. 4Vould you like [o receive tax statemen[s for this
property via e-mail? (Provide contact informarion
below. Please see ins[ruc[ions jor mare in�ormation.
M1bt available in all counties.
dG -�/-/.7 aoo -oa3. o1�/-Q�?7
6'-mail
Under penalties o(perjury, I hereby certify that this Sales Disclosure, [o [he best o(my knowledge and belief, is Crue, cortett
and comple[e as required by laµ�, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse informa[ion, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deductlon is
being filed.)
Signatu fB�.yerl Y �� �
,�'Li� 1 Q, C`i L(� 1� ii M',2 i-.20 /
Pnn�edLegal,YameojBuyerl � Sl4^��<�H.e/00/v»1�
�
LastSDigifsuj5ocial5etunryNUmbe�
Lirense/ID/OthenYumber
Signamre o(Buyerl/Spouse
Pnn[edLe,yalNameoJBuper2/Spousr SignDate�M.a/DO/YY1'YI
LastSdigitsofBu}'er2/SpauseDnver's Smte Last50igi[so(Social5ecunry
Number License/!D/0[herNUmber
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