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iS DISCLOSURE FORM SDF ID:
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Reparero/the Sala Disrlosvre Form
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19 .. FOURTH ST., STE 500
Ciry, Smte, m • �
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Seller 1- M1'ome as a mrs an ronveyanre
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Seller2�Nameasappearsonconveyanre�jo vmen[
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Addrea (A'vmber and SveetJ
Ciry, Smre, and ZIPCade
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Under penalties of perjury, 1 hereby certify that [his Sales Disdosure, to the bes[ of my knowledge and belief, is tnie, torrect
and com le[e as r ire�y law, and is prepared in accordance w�[h 6-11-5.5, "Real Proper[y Sales Disclosure Act".
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Bu}�er]�Nameosapearsonronveyunredxv ent Buyer2-Nameasappeorson[onveyanreda'umen[
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ress (Number and Sveet) Address (Number and SveetJ
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Ciry,
� E-mail TelenhoneXumber � E-mail
TNE SALFS DISCLOSORE FORM MAY HE USED TO APPIY FOR CERTAI\ DEDUCTIONS FOR THIS PROPERTY. IDE�TIN ALL OF TNOSE TNAT APPLY. �
� � 1. NJill [his property be [he buyer's primary
residence? Provide complete address of primary
/ ^,�� � re,sitience, inclyr�inQ cpun��
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Ciry,S`�e,�PCade lounry
� �/�{, 2. Does [he buyer have a homes[ead in Indiana to be
�T� vaca[ed for this residence? If yes, provide
complete address of residente heing vacated,
induding county:
dddrvs �A'um6er and Street)
Ciry, Smre ZIPCade Counry
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3. Homestead
4. Solar Energy Heabng/Cooling System
S. Wind Power Device
6. Hydroelectric Power Device
7. Geo[hermal Enerey Heabng/Cooling Device
8. Is [his property a residential rental property?
9.41'ould you like [o receive tax sfatements for [his
property via e-mail? (Provide conmct informotion
6e/ow. Please see instrucpons for more information.
Not availa6le in all coun[ies.)
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arvnmuerNOwnerron v name E�mail
Under penalties of perjury, 1 hereby certify tha[ this Sales Disclosure, [o the best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance wi[h IC 64.1-5.5, "Real Proper[y Sales Disclosure Ac[". (Note:
Spouse informa[ion, Social Seturity and Driver's License/Other numbers are not necessary if no Homes[ead Deduction is
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Las[Sdigi[sofBuyerlDriver's Stnte Las[SDigiaoj5xialSecuntyNumber
License/ID/O[her Num6er
LastSdigiGSO/'8uyer2/SpauseDriver's Stnte LastSDigi[sof5ocial5ecurity
Number Liceue/ID/OtherNumber