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FORM
Rav M. Drulev Attornev No. 4759-26
Preparu ofNe Sala DBdosnre Fortn 7y4e
Law Office of Rav M Drulev
Company •
Fort Branch. IN 47648
'
I- Name as oppenrs on conveyvnce docvmmt
Address (Number ond StreetJ
[iry, Smcg
�- / _'
of perju'ry, t hej,�by certify that this Sales Disdosure, [o the best of my knowledge and belief, is true, correc[
reguir�d by I�i� and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Bvyrr I- Nome as appeors on ronveyonce dacummt
THE SALES DISLLOSURE iORM MAY 6E USED TO APPLY FOR
Q✓ � 1. Will this property be the buyer's primary
residence? Provide comple[e address of �
residence, including county:
SjgnoNre o(Seller
7 Pn"n[edNomeo(Seller SfpnDat
X�DEDUCTIONS=�IUENT,IFY;RLL ITEMS;THAT;AP.,PCY�;�?�
evyer 2- Nome as appevrs om m�veynnre dxummt
Addr�s (Number ond SVeetJ
City, Smte, and LYCode
Tefe honeNUmber
FORTHISP ALLO PPLY.
YES NO CONDRION
� 3. Homestead
n 4. Solar Energy Heati o ing Sys[em
1904 S_ Boulevard Place
Addra's(NUmberandSVreQ
Princeton.IN 47670 Gibson
Ciry, Sfnte LP Lade Counry
� � 2. Does [he buyer have a homestead in Indiana [o be
vacated for [his residence? If yes, provide
complete address of residence being vacated,
including county:
Add�ar[Numberand5veet)
City.SmreZIP
Counry
❑ �
❑ �
❑ �
❑ ❑✓
S. Wind Power Device
6. Hydroelectric Power Device
7. Geo[hermal Energy Heating/Cooling Device
8. Is this property a residential renWl property?
9. Would you like to receive tax s[a[ements for [his
property via e-mail? (Provide contat[ informadon
belaw. Please see instructions for more ' formatlon.
Not available in all mundes.) C�*
�� �a_�g -30�1 aoa. 507-00
name
E-mail
Under penalties of perjury, l hereby certify tha[ [his Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as required b w, and is prepared in accordance wi[h IC 6-1.1-5.5. "Real Property Sales Disclosure Act". (Note:
Spouse ' ation, Soci Sec rity and Driver's License/Other numbers are no[ necessary if no Homestead Deduction is
bei �I .
$qn veof8� ''� I SqnaNrea(Bvyer2/Spouse
License/ID/Other Num6er
PdntedLegolNameo(euyer2/Spouse 5(gnDate�NH/DD/YYYYj
LastSdigitro(Buyer2/SpouseDriver's Smre LastSDigiGSOfSocial5ecuriry
Num6er Lirente/lD/OtherNum6er