Homestead_Harris (10)L�
INDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
D: PREPARER ., s ' � .n, ; �: -w ' _ :� ' .,, ,��-'.> :� .��;..�sr a _ � • . ..-,, :
n �.c.. -e _ a. "4: . t;,. ... Yto-.-4« � ��.+:1 r.. . . "r.a:i.'1 .�.v . -a..ra s -. . �.v::.f . �.::, ...� �.. � �. .. -
Patricia Koib Closino Manaaer
�Reparero/rhe Sale D'udmvre Form Title
126 W. Broadwav Broadwav Title. Inc.
Addras (Rumbrland SteetJ Comyvny
Princeton, IN 47670 (
mail
. . �.� -, ...ra z � . �
E:SELLER S ' GRANTOR S ,- �..° �: �?`='.' _ ,.4--t:, • s,.:.�. . . 2 � . .�, ,�— � . -
.. .4. I , d, h: ' .- ._3 � .(.�. - -� '.> .. . �
Patricia D. Vanoven
Seller 1- Na�nre datument Sellrl2 - Name aa appmrs w convryanre docvment
10A S. 8roadview Circle Dr
Addr¢v(NumberandStrcet) Address(Numberand5tm[J
Princeton.IN 47870
liry, Smre, and Z/PCode Ciry, Swtt a�d ZI7Code
_
TAe honeNUmber E-mvil
Under penalties of perjury, I hereby certify tha[ this Sales Disclosure, [o [he best of my knowledge and belief, is [rue, correct
and plete as r uired by law, and is prepared in attordance with IC 6-11-5.5, "Real Property Sales Disclosure Act".
��;/..��t) l/�..��..�i
Agnomreo(Seller SignaNrco(Seller
Pairir.ia D. Vanoven 07/28I2010
PnnredN Si nDafe MMOD Pn'nudNameo Seller Si nDate MMOD
F YER S GRANTE S'-APPCICATIOMFOR'PROPER71'TAXDEDUCTIONS= IDENTIEY,ALLdTEMSTHAT`AP.PLY', ' '•
Michelle K. Harms
vu7�Nameasa mnvryancedocumm[ Buyn2�Nameosappearsontonvryanttdacumm[
251 W SR 64
AdEress(Numboand5treel) Addms(Numberand5vtet)
nnceton IN 47670
iry, SmtG and ZlPCode [iry, Smte andZ/PCode
`
Tele haneNum6er E-mail
THE SALFS DISO.OSURE FORM MAY BE USEO TO APPLY iOR CERTAI� DEDURIO\5 FOR THIS PROPERTV. IDE\TIFY ALL OF THOSE THAT APPLY.
1"FS KO CO\DITION ,'O CONOITIO\
❑✓ ❑ 1. �Vill [his property be the buyer's primary �✓ � 3. Homestead
residence? Provide complete address of primary � eating/Cooling System )!(p
residence, including county: � �J
_$23 W. Wood St. ❑ ❑✓ S. Wind Power Device `q5�
Add�es(Numberand5vee[) ❑ Q✓ 6.Hydroelec[ricPowerDevice
Princeton IN 47670 Gibson � Q 7, Geothermal Energy Heatlng/Cooling Device
Ciry, SmteZIP lade Covnry
❑ ❑J 2. Does the buyer have a homes[ead in Indiana to be � ❑✓ 8. Is [his property a residential rental property?
vacated for this residence? If yes, provide ❑ ❑✓ 9. Would you like to receive ta�c statements for this
complete address of residence being vacated, property via e-mail? (Provide contact in%rmadon
including county: below. Please see instructions for more information.
Not available in all counties.) C O�' �c.'�
Addres(Num6nand5treet) � �� � �� - � a -� o y -mo.�5"9-o a�
�1 (
Ciry, Smte2lPCade Covnry
Pdmarypmpertyownermnraaname E-mail
Under penal[ies of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is [rue, correct
and comple[e as required by law, and is prepared in accordance with IC 6d.1-5.5, "Real Proper[y Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are no[ necessary if no Homestead Deduction is
being filed.)
:�,ch�.Q�. K d�cun�
Sign reofBuyerl SignamreofBUyu2/Spouse
�hPlleK Harms OV2AI2010
'
.
LastSdigiao/BuyerlDriver's Sta[e LastSDigicso/Social5ecurityNum6er LattSdigitsOfBuyer2/SpouseDriver's S[ate Lost50igiGSa/Sacial5ecunty
Lirense/ID/OtherNumber Num6er License/lD/OtherNum6er
✓