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Under penal[ies of perjury, l hereby certify that this Sales Disclosure, to the best of my knowtedge and belief, is true, correct
an .ompiete as requlred by law, and is prepared in accordance with C 6-] perty Sales Disclosure Act".
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SALES DLS[LOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDIlCT10N5 FOR THIS
�� 1. Will this property be the buyer's primary �
residence? Provide complete address of prima
residence, including county:
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Qdrrss (Number and Strre�J
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❑ � 2. Does the 6uyer have a homestead in Indiana to be
vacated forthis residence? Ifyes, provide
comple[e address of residence being vacated,
including county:
Addrecs (NUmbrr ond Strn[J
Ciry.Smu Z/PCode Counry
Buyer IM�ome as appears on ronveyonae docvmmt
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Address (Numb.e(r1ond Strn[)
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'ROPERTY. IDENTIFY ALL OF TNOSE THA7 APPLY.
3y NO CONDITON
J ❑ 3. Homestead
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a-ae+a�tnergy tieatlng/Cooling System
S. Wind Power Device
6. Hydroelec[ric Power Device
� 7. Geothermal Ener� Hearing/Cooling Devite
�8. Is this property a residential rental property?
� 9. Would you like to receive [ax statemenGS for [his
property via e-mail? (Pravide contact in%rmotion
below. Please see instructions for more infarmatian.
Not availa6le in al! coundes.)
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Rimarypioperry ownn mr.mt[ name _..,...
Under penalties of perjury, t hereby certify tha[ this Sales Disclosure, to the bes[ of my knowledge and 6elief, is we, corrett
and comple[e as required by law, and is prepared in accordance with IC 6-11-5.5, "Real Property Sales Disclosure Act". (Na[e:
Spouse intormatlan, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
be(ng fil . ,�/
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