Homestead_Pancake:
I\DIA\A SALES DISCLOSURE FORdi
SDFID
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SDO ID
676895
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Pag'c 2 �
D.PREPARER:•-. - -. �- � . . - � - . -' � � --
,'�Patli Kolb Closing Manager
Reyarero(the Scln Uiulosvre Form 7iUe
226 W Broadvray Broativray Title, Inc.
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Gn SmrqandZlPfode TefryhonnYUmber E-meil
E.SELCER S /GWINTOR S ' �
Gibson Counry Habitat for Humaniry
Srller ]� A'ume usappeors om m�vevonw document Selier2 � Nvme nsuF➢evaan �onw.ryun<e doavment
1721 $. $lOUI $i.
Addrezs(NumberandStrraJ ACdrctt(A'umberand5:reey
Princeton, IN 47670.
Ciry, S:atc, ondZlPCode Ciry, Sm:c, anAZIP Cadc
E-moil Tde oneNUm6m E-moil
Under penalties o(perjury, I hereby certify (ha[ this Sales Disclosure, to the best otmy knowledge and belief, is true, correct
and co�e[�equi �� d is prepared in acco� ance with IC 6-1.1-5.5, "Real Property Sales Disclosure AcC.
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.BUYERS GRANTEES - PLICATIONFORPROPERTYTAXbEDUCTIONS-.IDENTIFYAhLITEMSTHATAPP�Y
Jennifer B Pankake
Buyerl-Namensoppmrsanm �anreduvment Buyer2�Namevsappearsanronve�nncedo[umm[
4
Addres(h'umberand5treetJ Addr¢s(,Vum6erondSVntJ
Princeton, IN 47670.
;.Ciry.Smh.andZlPCoEe Ciry.Smre.andTlPCode
TJ MncNvmbe� Emc(I
'fHE SALES DISCLOSURE FORM MAY BE USEO TO APPLI' FOH CERTAIN DEDURIOYS i0R THIS PROPERTY. IDEIf�IF1' ALL Oi THOSE THAT APPLY.
YES YO [OVDRION NO COVDITIOY
Q � 1. Will Chis property be the buyer's primary Q � 3. Homestead
residence? Provide complete address of primary , ergy Heating/Cooling System
residence, including county:
728 E OHIO ST. � ower Device
Addrcit(NUmberandSUxo) ❑ Q 6. Hydroelectric Power Device
Princeton, IN a7670 NOT APPLICABLE � � 7. Geothermal Energy Headng/Cooling Device
Gry, Smu ZIP CoCe Caunry
�� 2. Does the buyer have a homestead in lndiana to be � 0 8� �s chis properry a residenrial rental propercy?
vacated for this residence? if yes, provide ❑ Q 9• 4VOUld you like to receive tax statements for [his
complete address of residence being vacared, properry via e-mail? (Provide contact informotion
indud ing county: be(ow. Please see instructlons for more information.
M1bt available in all counties.)
Addrerz (h'umber and SvreQ
�6-►a -IFs-ZOy-oa4 3GSaa�
Ciry, Smte ZfPCode Counry
Nimarypmpe�ryownerronmanume E-mail
Under penaltles of perjury, 1 hereby tertify that this Sales Disclosure, to [he best o(my knowledge and belief, is true, correct
and complete as required by IaH•, and is prepared in accordance with IC 6d1-S.S, "Real Property Sales Disdosure Ac[". (Note:
Spouse inform 'on, Social Security and Diiver's License/Other numbers are not necessary if no Homestead Deductlon is
b g filed.) , �
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SocmlSecunryNumber GostSdigiGSa(Buyer2/SpouseDnver's Smte LastSDigitso�Social5en�nry
Lirense/f0/OtherNumber Number License/lD/OtherNumber