Homestead_Mackayand ZIP Code
FoRn�
dacument
r
Telephone Number
Seiler 2- Name as appears on ronveyance document
and5treetJ
Ciry, Srute, andZlPCode
E-mail
7nder penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is h-ue, correct
md complete as required by law, and is prepared in accordance with IC 6•LI-S.S, "Real Property Sales Disclosure Act".
Signa[Lreo(Seller - -
L��a �
Pnn[ed A'ame o(Shcer
BUYER S ' GRANTEI
Bwer 1� Na as appears on
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Ad ress(A'um6erand5treo
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rte. andZlPCode
Da[e
Signa[ure ofSeller
Buyer 2- Name as appmrs on comeyance
Addrtss (Number and Stree[J
Ciry, Sta[e, and ZIP Lode
1'HE SALES DISCLOSURE FOMf MAY BE USED TO APPLY FOR CERTdIR DEDIIGTIONS FOR THIS PROPERTV. IDENTIFY ALL OF THOSE THAT APPLY.
��I, � 1.1Ni11 this property be the buyer's primary
� residence? Provide complete address of primary
a�i 3�esi ence%i�Od�Ct:fntyKO�
Address ^'° �berand5treet) �
�r� n e�7�tm , Ln% y-7� 7�
Ciq•, Smre ZIP Code Counq�
�� 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 couoty:
Address (A'umber arsdSvee[)
Ci.y, Sm[e ZIP Code
Launry
7
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7
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3. Homestead
4. Solar Energy Heating/Cooling System
5. Wind Po�ver Device
6. Hydroelectric Power Device
7. Geo[hermal Energy Heating/Cooling Device
8. Is this properry a residential rental property?
9. 4Vould you like m receive tax statemenrs for this
property via e-mail? (Provide contoct in�ormation
below. Please see instructions for more information.
Notavailable in all counties.)
�/ -6? -� 5-�0o aT�..��/.a a7
i
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as reqwred b aw, and is prepared in accordance wi[h IC 6-11-5.5, "Real Property Sales Disdosure Act". (No[e:
Spo �' ,rma 'on, S ecyjity and D� r's License/Other numbers are no[ necessary if no Homestead Deduction is
be' filed. �
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e(M.N/�D/YI'VYJ
Security Number
Signanire o/Buyer2/Spouse
PnntedLegalNameo(Buyer2/Spouse Si9nD0:¢(MM/DD/YYY1J
LastSdigifso(Buyer7/SpouseDriver's State LastSDigiuo(Social5ecuriry
Number License/ID/Other Num6er