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SDFID:
Title
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Company
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Sdfer 1� Name as appmrs on ronveynnre dorumml
3,3ss t iov N
Addre (NumberondStrre[)
f�i„«t�rr . z-rV u'�r� �n
Under penal[ies of perjury, 1 hereby rertify that [his Sales Disclo
and comple[e as required by law, and is prepared in accordance
s� m�eu�.��C!+�L—�—ti� �;
oar�
Seller 1- Name as appears on conveyvnce dorumm[
_ �s� F �oo N
Ad (Numberand5treetJ
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��
of my
THE TO APPLY FOR CERTAIA' DEDUC710N5 FOR THIS PROPERTY. IUEI.TIFI' ALL Oi THOSE Tf1AT APPLY.
�� 1. Will this property be the buyer's primary
residence? Provide complete address of primary
r idence, includin county:
3aa 1� a�c•,� �.
Address(Num6er ndS[reetJ � \ '']�
�� \rCQ,�o-T�i 1 �I`I �I T� ��
Ciry.Sm[eZIPCade Caunry
� � 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence beirtg vacated,
including county:
Addrrss (Number ond StrerQ
Ciry. Smte Z!P Code
Counry
belief, is we, correc[
Disclosure Ac[".
� �E " 3. Homestead
� [� 4. Solar Energy Heating/Cooling System a�
h�
� Q 5. Wind Po�ver Device �
❑ Q 6. Hydroelectric Power Device a`�\
❑ Q 7. Geothermal gy Hea[ing/Cooling Device
� Q 8. Is thi p operty a residential rental property?
❑ Q 9. W r�d like [o receive tae statements for this
y��g�operty via e-mail? (Provide contact in%rmotion
���\ below. Please see instructions for more in(armation.
Not available in a!f counties.)
�1c�-I a-o'7 ia3 Lbb ��[� Da �
Pnmary pmperry owner tnnlac[ name F-mail
Under penal[ies of perjury, 1 hereby cer[ify [hat [his Sales Disclosure, [o the bes[ of my knowledge and belief, is true, correc[
and complete as required by Iaw, and is prepared in accordance with IC 6-1.1•S.S, "Real Property Sales Disclosure Ac[". (Note:
Spouse information, Social Se�urity and Driver's Li�ense/Other numbers are not necessary if no Homes[ead Deduction is
being filed.)
�-�:,.���' ,P�,�.,, ��.1 � �.�C��
Signa[urt ofBuyerl �/�� ignoNre aJBuyerl/Spouse I I '� /�
(in�N:o��.O r�Y1/i�1�l�. 1N�.'J�.��`�I� ,....1. Cn..L-�- ,4L.Lt,ItT `-I-7/_%nl
Cdnred
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Latt 5 Digirs o(Social Seturity Num6er
Driver"s Smte Las[SDigi[so(SacialSecuriry