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/J ID'rl�4NA SALES DISCLOSURE FORDf
IPatti Kolb
/ Preparero/NeSolaDisdoiureForm
�'26 W. Broadway
� Addreu�Num6erondSReeQ
[iry. Smte.
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Ronald Dou 1 Hudson
Sellerl-Nomevsappmrs . mnvryvnmdocumen
1180 W 440
Addrcss (Num6er andStree[J
Patoka, IN 47666
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Closing Manager
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Broadway Title, Inc.
Company
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TeleOhone Number E�mail
Kathleen Jo (Blemker) Hudson
Sel/er 1- Name as appmrs on ronvryanre dxumm�
1180 W 440 N
Addrcs (Nvm6er and Svee[)
Patoka, I\ 47666
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Under penal[ies of perjury, l hereby certify tha[ this Sales Disclosure, to the best of my knowledge and belief, is [rue, correc[
ands,omp�le�te as required by law, d is prepared in actordante wi[h IC 6-1.1-5.5, "Real Proper[y Sales Disclosure Ac[".
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Signomreo/Sel/er S{gna[ureoJSeller �_
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F: BUYER(S)/GRANTEE(S��=APFLICATION�-FOR DEDUCTIONS�AN
Jessica D. Pitcher
Buper ]- Name as appnn am m�vryanre dotummt
P.O. Box 222
Address (Num6er and StreelJ
andLPCOde
Huyer 2- Name os apprors on conveyance documen�
Addrtss (Num6er and Sveetf
Ciry. Smtq and ZIP Lude
THE SALES DISCLOSURE FORM MAY BE USEO TO APPLY POR CERTAIN DEDIIRI ONS FOR THIS PROPERTY. IDEYTIFY ALL OF TH OSE THAT APPLY.
� ❑ 1. Will Ihis property be the buyer's primary
residence? Provide complete address of primary
,.� � ,� . residence, indpding counry:
tiry,5m¢ZIPCadr � Counry
❑ � 2. Does the buyer have a homestead to be vacated for
[his residence? If yes, provide mmplete address of
residence vacating, induding counry:
Address (Num6er and StrreQ
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CO\DITION
3. Homestead �
4. Solar Energy Hearing/Cooling System ���
5.4Vind Power Device ����
6. Hydroelec[ric Power Device
7. Geo[hermal Energy Hea[ing/Cooling Device
8. Is this property a residential rental property?
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Under penalties of perjury, 1 hereby certlfy tha[ this Sales Disclosure, to the best o( my knowledge and belief, is [rue, correct
and co�ete as required by_law, and is prepared in accordance with IC 6-1.1-S.S, "Real Property Sales Disclosure Ac[".
o(BuyeA
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Signamre of Buyer2