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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
RE PARER 1
FP'9WP
Brian rian K. Mahoney Attorney
I se reroftheSalesDisclusureForm ride
022 Main Street, P.O. Box 176 Mahoney Law Office
Address(Ne.ber.miStrect)
E-mail
E: SELLERS I/GRANTORS ) _7
Sheridan D Warner
Margie J Want r
Seiler I - Name as appears an conveyance document
204 Center Street
Seller 2 - Name as appears on conveyance document
204 Center Street
Address (Number and Street)
Francisco IN 47649
Address(NumberandStreet)
Francisco IN 47649
City. State and ZIP Code
E-mail
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as required I
red by la, and is prepared in accordance with -1 6-5.5, Re roper Sales Disclo ure Act".
SignaturenfSeller SignatureialSelle
Sheridan C. Warner &/- 12011 Marcie J. yva mer /2011
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YER(S)/GRANTgt,-,APPLICAT,,N.,ORPROPERT.Y,TAX.,,,i,—CprTin,��IFYA2,,EMSTHAT-APPLY,,---,-�-�,.'",
Charles O. McGowan
Vic ie C Mc wan
caredocanumt
BaveL2L2Nam!!e as !ap5pnwnaAa..ffViyaaw document
825 W
2143 N CR 825 W
Address (NumberandStreet)
Address (Number andStrect)
Hazleton. IN 47640
Hazleton, IN 47640
State, and ZIP Cade
__Qz State, andZIPCode
.0ry
,
E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THis P THAT APPLY.
YES NO CONDITION 90— CONDITION
1. Will this property be the buyer's primary
in s
3. Homestead
Homestead
,plete address of I
residence? Provide complete
<
a E System
4. Solar E
2�, Solar JLU
residence, including county:
S. Wind Power Device
204 Center Street
❑ d 6. Hydroelectric Power Device
Address(NumberandStrect)
\
Gi
Francisco, IN 47649 Gib on
% 7. Geothermal Energy Heating/Cooling Device
El
property
EJ E, 8. Is this proper a residential rental property?
C1O,SnawZIPCodc ce�umy
nv' ❑ 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
E] E-: 9. Would you like to receive tax statements for this
complete address of residence being vacated,
property via e-mail? (Provide contact information
including county:
below. Please see instructions for more information.
2143 N CR 825 W
Not available in all counties.)
Address (Number and Street)
Hazleton, IN 47640 Pike
0. 30
City, Store ZIP Code C. nty
Primary property owner contactnome Email
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License /Other numbers are not necessary if no Homestead Deduction is
bei d.)
Signature ofBayerl T 'Signacure ofoayer2lSpouse
_,,P_hAr1e,q 0 McGowan Vickie C. McGowan /2011
kgak`w�.
riated Legal Name offtyer I printed Legal Name ofBWer 2 /Spouse Sign Dow IMMIDDIYYYY)
V
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license /ID /Other Number Number License /ID /Other Number