Homestead_LinsdayIRDLNA SALE$ DISCLOSURE FOR\I $DF ID SDO ID 779060 • Page?
D.PREPARHR
Samantha Culsirper
Preyarer o/[he Sefes Diulosvre Fom
226 W. Broatlway
AJJrrn(NumGerandSUeeQ
Princeton,IN 47670- _
Qn.Sm:e, andZlPCOCIe
E. SELLER(S)/GRANTOR(SJ
Mary Matlison Estate of Josepttine R. Church
Srller 1- Namr as nppeon om m�reyvme J�nl�ment
502 W. Monrce St.
Address (Number and SareQ
Princeton, IN 47670-
N A
8roatlwaV Title, Inc.
Campony
SrRei Z� Nume as upyevn un �vmxwner daument
Addrot (A'umber cnd Svce[]
G.y.Smre. nnd7.IP la/e
Under penalties of perjury, I hereby certi(y that this Sales Disdosure, to the best u(my knowledge and belie(, is We, correct
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
on F Goo
/ -h'umens
IPaY� Y�
a,
sr3�o�,..o/s�ie.
'e
- APPLICATION FOR PROPERTY TAX DEDUCTIONS- IDENTIFY ALL ITEMS THAT APPLY
THE SALES DISCLOSURE i0Rh1 MAY BE USED TO APPLS' FOR
Burer? � n'vme os nppron on mm•e�nnreCxummt
2d.res (Numbr� anAStrert)
Ci.y. Smte. and %IP CWe
Tdenhuneb'mnber
x❑ ❑ t. 4Vi11 chis properry be the buyer's primary �
residence? Provide complete address of primary
residence, including counp�:
502 W MONROE ST.
.1 Adress (NUmber ond Svee�)
Princeton, IN 47670 GIBSON
Cip: Smce ZIP CMt Counn
� � 2. Does the buyer have a homestead in Indiana m be
vacated for this residence? I(yes, provide
complete address of residence being vacated,
induding counry:
Addras (A'um6er andSvrrt)
Ciry, Smce ZIP Code Counry
3. Homestead
� Q 4. Solar Hnergy Heacing/Cooling System
� Q S. 4Vind Power Device
� Q 6. Hydroelectric Power Device
❑ Q 7. Gwthermal F.nergy Healing/Cooling Devire
� Q 8. Is this property a re=_idential reniai property?
❑ Q 9. bVould,vou like to receive tax s�atemencs for this
properry via e-mail? (Provide conmct informotion
below. Please see instructions/'or more in�ormation.
M1bt available in all counties.J
�loia-o7�30300�/ d/�S'6a�!
Primuryprop<rtY oimer mnmct mm�e !'�mail
Under penal[ies of perjury, 1 hereby cer[ify that this Sales Disdosure, to [he best o(my knowledge and belief, is [rue, correct
and wmplete as required 6p laµ•, and is prepared in accordance with IC 6-11-5.5, "Real Property Sales Disclosure Ac[". (Note:
Spouse informa[ion, Social Security and Driver's License/Other num6ers are no[ necessary if no Homestead Deduction is
being f�e� (� , (� l n ^
3nnndLe,
Lirense/!D/O[her Number
51'�nvlL�P (I�BY)'eI?�$PO'JH
Pnn;edLegalNOmzojBu}•er7/Spwrsr SignDatr(an/DO/1YY17
Number I LastSdigicso(Buyer2/SpouseDnver's Sm[e GastSDigitto�5onclSetunry
Number I.irense/lD/0[herNUmber