HomeMy WebLinkAboutHomestead_BrinerINDIA7VA
Seller ]� Name as appears on conveyonce documenl Sdfer 2- N
9ot� � fv�arvs 3��
ACdrecs (A'umberand Sveet) Address (N
�R�NG�7�N . � �����
Ciry, SmtG and LPCode iry, Smre, �
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Under penal[ie ury, I hereb certi tha[ this Sales Disclosure, to the best of my knowledge and belief, is true, correct
a�ld c, o,�nple��equir b w, and is prep red in accordance wi[h (C� .1-S.S, "Real Pr� les Disclosure Ac[".
1 v� ( O �,.�.
S�gnaNre of5dler Sgnomre o(Selfer
mku_A..�C�C-'ncJ\Pz.7� ll�f'�l2oDi i�olnn��_�-�,�^v�n i��t�?��o09
+;n L- (jr;nzr
r ] - Name as annears�t
1��'0 'F�ate 5�
Address (Number and StreetJ
�rnc.+o� ,sN y'76'�b
�iry, Smt4 and LPCode
TNE SALFS DISCLOSIIRE FORM MAY BE USED TO APPLY FOR CERTAIY
❑ 1. Will this property be the buyer's pri�a�.
residence? Provide comple[e address o
� res(dfince, including yaymty:
' Ciry,5mre7JP[ode � Counry
❑� 2. Does che buyer have a homestead in Indiana ro be
vacated for [his residence? If yes, provide
complete address of residence being vacated,
including county:
Addres (A'umber and Street)
Ciry, Smte Z/PCode Caunry
Buyer 2- Name as appean on canveyanre daavment
Addres (NUmber and Stree[)
Ciry, Sm[G andLPCode
THOSE THAT APPLY.
YFS KO COYDITIOY \
❑ 3. Homeste d
4. S nergy Heating/Cooling System
❑ S. Wind Power Device
❑ 6. Hydroelech-ic Power Device
❑ 7. Geothermal Energy Hea[ing/Cooling Device
❑ 8. Is this property a residential renWl property?
❑ 9. Would you like [o receive Wx statemen[s for this
proper[y via e-mail? (Provide contact informa[ion
below. Please see instrucnons for more information.
Not available in all mundes.)
c�G-��-o7. 30�/- ooa.�la7_o�8
ronmc[name E-mall
Under penalties of perjury, t hereby certify that this Sales Disdosure, to [he bes[ of my knowledge and belief, is true, correc[
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Ad". (Note:
Spouse informa[ion, Social Securiry and Drivers License/Other numbers are not necessary if no Homestead Deduction is
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e of Buyerl �/[�
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Last 5 Digi[s of Social Seruriry Num6er
Signamre o/BUyer2/Spouse
PrincedLegalNamea(Buyvr2/Spouse S(qODa[e(HM/DD/YYYYf
LastSd{gi[safBuyer2/SpouseDnver's Sm[e Lat[SDigiaofSocialSecunry
Number Lirense/ID/OtherNum6er