Homestead_SchellerI\DI.\\'A SALES DISCLOSURE FOR)1
D.PREPARER
Samantha Cutsinger
R'ryanr of tAr Scfes Oiscbsu�e Form
AdJren (,l'umLer ond AieetJ
SUFID
T�tle
Broadway Title, Inc.
E. SELLER{S)/GRe1NTOR[S)
Chades C Wallace by Ead E. Chandler, guardian
Srller 1� Namr us ap�xvrs w mnrqxmae Javn. ent
1837 N. State Rd. 65
Address (Number ond SaeetJ
Princeton, IN 47670.
% A�, /�
Vemeta M Wallace
.WIlri I- Nemr m upp vn om m�varyvnve dorurnent
1831 N_ State Rd. 65
dCdrtn (Kumber ond 5✓ee[)
Princeton,IN 4767P
'
�
ury, I hereby cer 'f that s Sales Disclosure, to the best of my knowledge and belief, is true, correct
ed by aw, is r n a�r�lance with IC 6-1.1-5.5, "Real Property Sales Disclosure AcC.
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��h � Si.anotureafSeller
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�1 - APPLICATION FOR PROPERTYTA.K D �-
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idephnneNurnber Emoil TefeyF.vrteM1'mnGrr E-mail
THE SALES DISCLOSURE FOR>t MAY BE USED TO dPPLY FOR CERTdIN DEDUCf10\S FON TIIIS PROPERTY. I OENTIFI' ALl Of THOSE THAT APPLI'.
Q ❑ 1. 4Vi11 chis properry be che buyer's primary
residence? Pro��ide complete address of prima �
residence, including rouniy:
1831 N. STATE RD. 65
Addrrss (NUmbrr ond Scne[j
PnnCeton, IN 47670 GIBSON
Cin; Sm:e ZIP Code Counry
� � ?. Does the buyer have a homesiead in Indiana to be
vacated for this residence? Ifyes, provide
complece address of residence being vacated,
induding county:
Addrrs� (n'umber ar.d5•vee:)
Ciry. S�atr ZfP CWe
Q � 3. Homestead
� cn 4. Solar Ener9
5. �Vind Power Device
6. Hadroelectric Pou�er Device
System
� Q 7. Geothermal F.ner�v Heating/Cooling Device
� Q 8. Is this propern� a residential renial property?
� Q 9. btbuld you like to receive tas statemen[s for this
property via e-mail? (Provide contact informotion
belmv. Pleose see inscructions jor more information.
Not available in all counties.)
— ��-a5-3/ yoo 0o a Go 3•o�
Covnrv
fhimarv D�Oe�O' orvner ror.mrt nume 6' mail
Under penal[ies o(perjury, I hereby certi(y [hat [his Sales Disclosure, [o the best o(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 Act". (Note:
Spouse information, Social Security and Driver's License/Other
Lnsf>digicso(Bu}•er2/SpovseDriver's S[c[e LastSDrgi[so�SorialSecunty
Licensz/ID/Other,Yumber h'umbe� LBense/ID/OrhenVurnber
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