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Seller ]- Name as appears om m�veyanre document
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Addr�s(yrym6erandStrett)
Yr,' nr e�� .�/ �f 7�O 70
liry, Sm�e, and7lPCode
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Sel/er I� Name as appears on conveyance document
Slo �77 .ti ��C7 �
Addr (NumberandStrret)
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Under penalties of perjury, t hereby certify that this Sales Disclosure, to the best of my k¢owledge and belief, is true, correct
and comp te as reqmred by lae�, and is prepared in accordance with t G= .1-5.5, "Re G�Pro erty Sales Disclosure Act".
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5{gnomreo(Seller � / 5(gmmr Seller ��
_ �� �.✓ � I! 3� / 1 ��! rn � � ��'� �,o r � �1.� l/ l
Name as appevrs
THE SALES DISCLOSURE FORM MAY BE USED TO APPLi' FOR CERTAIN DEUURIONS
� � 1. Will this property be [he buyer's primary �
residence? Provide complete address of p ry
residence, includina co nty
� (`�h2 i� % 1`�r-.`. � f� � �� .
Addrgs(NumberondStree[) , � � � _ � •,
Ciry, Smre7JPCode Lounry
�� 2. Does [he buyer have a homestead in Indiana to be
vaca[ed for this residence? If yes, provide
complete address of residence being vacated,
induding counry:
Addras (A'umber and SPee[)
liry, Smre ZIPCode Counry
THAT.APPLY
Buyvr 2- Name as appaors an ronveyanredoavmenn
Addrnz(Numberand5tree[)
andZlPLode
APPLY.
� 3. Homes[ead
5. Wind Power Device
System
❑ QI 6. Hydroelectric Power Device
❑ QI 7. Geothermal Energy Hea[ing/Cooling Device
❑ I❑ 8. Is this property a residential rental property?
� IQ 9. Would you like [o receive taac statements for Chis
� proper[y via e-mail? (Provide contoctinjormation
� 6elow. Please see instructlonsfor more informa[ion.
Not availa6le in aII counties.)
�� ��a� ,�o�-oa�. 2.�0-0��
Under penalties of perjury, t hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance with IC 6-11-5.5, "Real Proper[y Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
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Sipnamre o(6uyer2/Spovse
Prin[ed Legal Name af Bu}er 2/Spouse
S{gn Da[e (Mb/00/YYYYJ
Num6er I Las[SdigiGSOfBuyer2/SpouseDriver's Sta[e LastSDigi[sojSotial5ecurity
Num6er Lirense/ID/OrherNumber