Homestead_Miskell (14)I\'DIA\.\SALES DISCLOSURE FORDI SDPID SDOID 724733 Page2
D.PREPARER
�Samantha Culsinger
Reyarerof [hr Scln Diulasvre form Tltle
226 W. BrOadway 8roadway Title, Inc.
AJJress(NumLeroMSberQ Company
Princeton, IN 47670.
E.SELLER S GRANTOR S
Ethel M McReynolds Clayton Dy Denny R. Clayton, POA
Sel(er ]- Namr as nppwvn on aunveymir Jurument Sr/fer 2- Nume n� appear� om m�veyvn�e dm vmrn�
610 Kennedy Dr.
Ada�ess (Number and SvrerJ AQdms (A'umber anCS:reer)
Princeton, IN 47670.
c�: sm�a o�anr coe< e,ry, sro:�. ��n ziP eode
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Tele honeNumber E�mall
Und � penalties of perjury, 1 hereby cer[ify that this Sales Disclosure, ro the best of my knowledge and belief, is true, correct
an c mplete as required by la , a� ' prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
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Sigwmr dler Signamreaf5cifer
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F. BUYER S IGRANTEE S-APPLI ATION FOR PROPERTY TAX DEDUCTIONS- IDENTIFYALL ITEMSTHATAPPLY �
Rebecca A Miskell
B�p•er i� Kume ns oppcars on ronvevanre davment Buyer 2� Nome us appearsm mnvrynnre document
400 S. Main St.
dddre.a (A'umcer andSUmtJ AEdrns (Numbrr enC Strn��
Ft. Branch, IN 4764&
mail Tde hmeA'um6er Email
THES,ILESDISCLOSUREfORMM1IAYBEU5EDT0APPLYFORCERTAINDEDUR10N5fORTHISPROPERTV ENTIFI'ALLOFTHOSETHATAPPLI'.
YES NO COYDITION NO COADITIOY
Q � 1. Will [his properry be[he buyer's primary Q � 3. Homestead
residence? Provide complete address of primary 4. Solar Hnergy Heating/Cooling System
residence, including munp�: ❑ �
610 KENNEDY DR. 5. 4Vind Po�ver Device
Address(Numbercnd5neerJ ❑ Q 6. Hydroe�ectric Power Device
Princeton, IN 47670 GIBSON � � �. Geothermal Energy Heacing/Cooling Device
Ciry, Sm:e ZIPCoCe Countv
�� 2. Does the buyer have a homestead in Indiana to be � � $� Is this properry a residential rental propercy?
vacaced tor [his residence? If yes, provide ❑ Q y ��'ould you like to receive tax statements for this
mmplete address of residence being vacated, properry via e-mail? (Provide conmct rnformation
induding county: below. Please see instructions/'or mare in(ormotion.
Not available in all counties.J
Addren(hbmbrrar.d5'vtt:) 2��-�a-o �-��a -o�o.µ,o -oa,�
Ciry.SmuZfYCOde Counry
lTimarypmpe�p� o�mer �ar,mR name !'-mail
Under penalties o(perjury, I hereby certify that this Sales Disclosure, to Ihe best of my knowledge and belieG is [rue, correct
and complete as required by law, and is prepared in accordance wi[h IC 6-1.1-S.S, "Real Proper[y Sales Disclosure AcC. (Note:
Spouse in(ormation, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
bei ile .J �
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LastSdig�G�ofBuyerlDriver's Slare Last3Diginoj5xiolSecunryNumber LastSdigiao(Bu}•er2/SpauseDnveh State CastSDigi�so/Social5ecunry
Licerue/lD/Oth.erNumber Number Litense/10/O[herNumber