Homestead_DecorrecontINDIANA SALES DISCLOSURE FORM SDF ID: ' Pa e Z
.D. PREPARER - . , . . _ .. , - , :
SHERI L. GREENE
Preparer o(the Salu Disdosure Form Title
+ 7 22 E OHIO ST
recs(Num6erandSVee�J �omG�^Y
rRINCETON IN 47670
E-mail
E. SECC6R S GRANTOR S�: �
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Seller ]- Name os appevrs on conveyanro domment Sel/er Z- Name os appears on conveyance documen�
n�n� c 1100 F 47R7 S 1100 F
Address (Number and Svee[f Address (Number ond Shee[)
(IAKI ANn ('ITY IN 47660 OAK�AND CITY IN 476R0
Ciry, Srnre, and ZIPCode Ciry, Srnce, and ZlP Code
E-moil Tele honeNumber H-mail
Under penalties of perjury, 1 hereby certify that Ihis Sales Disclosure, to the best of my knowledge and belief, is [rue, correct
and complete as required by la�v, and is prepared in accordance �v�jh IC 6-1.1-S.S,' Re Property Sales Disclosure AcY'.
�f�-r.�/ ,� B���e �I�iL�fn�1 a K ��A(�lu�
Stg�reo(Selle� Signam aJSeller
VIR(;INIA K MARnN 08/ � 7/?012
Pr , amea Seller Si nDa[e(MM/DO PnntedNameo Seller SionDatefMM D
. BUYER S GRANTEE S=AP LICAT(ON FOR PROPERTY TAX DEDUCTIONS- IDENTIFY ALL ITEMS'THAT APPLY
ME INDA . D V
Buyer]-Nameatappevrs �eyonredocumm[ Buyer2-Nomeasappearsomm�veyanredocumen[
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(Num6er ond StreetJ Address (Number and Slree[)
4KIAND CITY IN 47660
Srnte.
E-mail Tele honeNum6er E-mail
THE SALES DISCLOSORE FORM MAY BE USEU TO APPLY FOR CERTAIY DEUURIONS FOR THIS PROPERTY. I DENTIFY ALL OP THOSE THAT APPLY.
YFS .�'0 C09DIT10.�' NO CONDITIOH
� ❑ 1. �Nill [his property be the buyer's primary � ❑ 3. Homestead
residence? Provide complete address of primary gy Heating/Cooling System
residence, including counry:
❑ � 5. Wind Power Device
�m�cRR57
Address(A'umbeiand5vee�J � � 6. Hydroelectric Power Device
OAKLAND CITY IN 47670 GIBSON � 0 7. Geothermal Ener� Heating/Cooling Device
Ciry, Srnre ZlP Code Counry
� Q 2. Does the buyer have a homestead in Indiana to be � 0 $• �s [his property a residential rental property?
vacated For this residence? If yes, provide ❑ � 9• Would you like to receive tax statements for [his
complete address of residence being vacated, property via e-mail? (Provide contact information
including county: 6elow. Please see instructions for more injormation.
Not available in alI counpes.)
Address (Num6er and Shee[) �
a1�-zo-i5-tioa-ax�o6� cx�
City. Smre Z/P Code Caunry
� Pnmory properry owner conmct name f-moil
Under penalties of perjury, 1 hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as required by la�v, and is prepared in accordance with IC 6-1.1-S.S, "Real Property Sales Disclosure Act". (No[e:
Spouse information, Social Security and Drivers License/Other numbers are not necessary if no Homestead Deduction is
b`�� ed. �
� / �
oNre of Buyer7 Signamre of Buyer2/Spovse
�nnooc�/nniT OR/I �J19019
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LastSdigiGSO(BuyerlDriver's Smre LastSDigitsofSocialSecuriryNumber LostSdigi[sa(Buyer7/SpouseDriver's Smte LastSDigi[so%SocialSecurity
' License/ID/OtherNum6er Num6er License/ID/OrherNum6er