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INDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
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DEBBIE JACKSON � TYPIST
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530 FREDERICA STREET � FOREMAN WATSON LAND TITLE
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OWENSBORO KY 42301
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SAler 1� Name m oppeors on ronveyance davmm[ Sdfu 2� Name us appears on canveyonce document
3AR� C,ERTON HI(:HWAY
ACdrec(Num6cand5veey Add�m(NvmberandStree[J
_fiERTON NC 7A735 �
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Under penalties of perjury, I hereby rertify that [his Sales Disclosure, to [he best of my knowledge and belief, is tne, correct
an mplete 7a7s, r�e�q�uired/,by law, and is prepared in accordance with IC 6-11-5.5, "Real Property Sales Disclosure Act".
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Si nDatr NH D Prin4dNameo Seller Si nDate wi1 0
,F.+BllYER" ' GRAN;TE � APP,tiiGATION]FORSPROPER•1YFT z � �dLti'.f-'fE?AS�THAT'rAPPL - '� ` ""
D� R S NA S. CLARK
Buyerl-Nameas onaonv anoedorumrs[ � Boya2-Nnmeaso comxyanttdwument .
428 S. MAIN STREET EET
Addr¢u(NUm6rrand5vee[J Addres(NUm6erand5treer)
PRINCETON. IN 47670 PRIN�ETON IN 47670 �
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1HE SALES OISCLONRE FO0.M �fAY BE fISEO TO �PPLY FOA CF.NTAIN DmUGTiOI:S FOR Tf115 FROPERTY. IDEATIFYALL OF TI10SE TIUT AV VI.Y.
YES NO COM1DRIOY YES NO COYDITION
❑✓ ❑ 1.1Ni11 this property he the buyer's primary ❑✓ ❑ 3. Homestead
� residence? Provide complete address of primary � � 4. Solar Energy Heating/Cooling System
`� residence, including county:
-/ o�g S iY'1 c„i � S'�. ❑ �✓ 5. Wind Power Device
Addrcs(NumbvandSUeet) ❑ ❑J 6. Hydroelectric Power Device
Pv i n e � i-o ..✓ .?�✓ �� 6 7 0 � G� 6 s o+t � Q 7, Geothermal Gnergy Headng/Cooling Device
Clry, Sru�e ZlPCode Ceunry .
[v� ❑ 2. Does the buyerhave a homestead in Indiana [o be � ❑✓ 8. Is this property a residential rental property?
vacated for this residence? If yes, provide ❑ Q✓ 9. Would you like [o receive tax statements for this
comple[e address of residence being vacated, property via e-mail? (Provide conmct information
inc}l {ding c un : beloiv. P(easesee instructions for more information.
Not available in a(! counties.
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Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correc[
and complete as required by law, and is prepared in acrordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse informa[ion, Social Security and Driver's Li[ense/Other numbers are not necessary if no Homestead Deduction is
being filed.) � � /�q ��j��/
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LostSdigi[so(Buyer2/SpouseDrlver'r Smre Last501glao%SoeialSecvnry
Liceue/ID/O[her Number Number Grense/10/O[her Num6er