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INDIANA SALES DISCLOSURE FORM
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LANA CHARPER CLOSER
Preporera'the Sales Disclosure Form Title
�_ 19 NW 4TH STREET STE 500 TOTAL TITLE SERVICES, LLC
Addres(Number and Street)
E -mail
E SELLERS' GRANTOR S `F- 'I(
AMANDA J RAI L N /KIA AMANDA J. WAL LACE
SelPler I - Nome as appears on conveyance document
Seiler 2 - Name as appears on conveyance document
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Address (Number andstrmt)
Ciry�I�
Email
I Telephone Number E -moil
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
a complete as required by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ".
nature afSelle Signature of5eller
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• Prm o er Si nDate MM DD Printed Name o Seller an
U FOR PROPERTY.TAX DEDU — DENT � ITEMS THAT APPLY,
KELLY J. BESING
DAWN M. JORGENSEN
Bayerl Nameasapp dda-aument
Buyer2 Nameasappea co nveyanredocument
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�rrs(Numbernnd veet)
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YES NO CONDITION CONDITION
❑ 1. Will this property be the buyer's prima
FX ❑ 3. Homestead
residence? Provide complete address of imary
4. Solar Ene ating /Cooling System
residence, including county:
1 417 l= • �� s
E] S. Wind Power Device
❑ 6. Hydroelectric Power Device
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❑ 7. Geothermal Energy Heating /Cooling Device
❑ 8, Is this property a residential rental property?
Ciry""" m�W Plode County
❑ 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
❑ 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.
Not available in all counnttiees..)
(,(/•1/1�/ /t /
Address (Number and Street)
G.�`�
City. State ZIP Code Counry
Primary properryawner contact name E mail
Under penalties of perjury, 1 hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and comple as required bylaw, and is prepared in accordance with IC 6- 1.1 -S.5, "Real Property Sales Disclosure Act ". (Note:
Spouse inf on, Social Security and Driver's License /Other numbers are not necessary if no Homestead Deduction is
being f
'a of Buy S- nature ofB•ryer2/Spoxse
,
License /ID /Other Number Number License /ID/Other Number