Homestead_PuckettINDIANA SALES DISCLOSURE FORM SDF ID 26- 2009 - 1000428 � Page 2
D..PREPAKER ;`ir.•,
SAMANTHA CUTSINGER BROADWAY TITLE, INC.
226 W. BROADWAY
PRINCETON, IN 47670
Clm, State. and LP Cade
NICHOLAS S RILEY
Seller - .V'ame as appears on tattvg lace davmerl
3414 5.Sie.kU 57
Adkexs (Number aril Street)
pnoa.JCA C; }�z T-j L+-24o
penalties of perjury, 1 hereby certify that this Sales Disclosure. to the best of me knowledge and belief, is true, correct and
to as required by law, and is prepared in accordance with IC 6- I.1/ -5.5. "Real fPrroopertyy Stales Disclosure Act".
A �c 1 101711m - pk41Yrt2 119 oil A,.
Primed .V'ame o'Seller Sign Date (AfAfDD01TY)
JAMES R PUCKETT
Btaer -. \'amt as a,,ears a,t e.m nee doevnrera
13363 E
Addren (,VUmhcr and Strew,
OAKLAND CITY, IN 47660
City, Slate, and ZIP Cade
(
r 1. Will this property be the buyers primay residence? Provide complete I r- 3. Homestead
address of primary residence, including county: r 4. Solar Energy Heating/Cooling System
3414 S STATE RD 57
Adrkem (Number andStreeti
OAKLAND CITY, IN 47660 Gibson
Or" Slate, umIIIPCak Comm
j— 2. Does the buyer have a homestead to be vacated for this residence? If
ycs. provide complete address of residence vacating, including county:
Addn•.0 (Nto te, and Street)
OD•. Sate. and EP Code C tm,
A LL OF TI IDS E TIIAT
r: 5. Wind Power Device
r, 6. Hydroelectric Power Device
F- 7. Geothermal Energy Heating %Cooling Device
r S. Is this proper' a residential rental property?
r 9. Would you like to recieve tax statements for this property via
e -mail? (Provide conma information below. Please see the
instruction' for more inj-ormalio�S'at available in all coumies.)
unaer penatues of perjury, i nerery cermy mat inis gates utsciosure, to me rest m my Knowteage ant Deuel. IS true, correct ana 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 Licensetother numbers are not necessary if no Homestead Deduction is being filed.)
Printed Name of `Burr.
Sign Dote pttMrDDOIIY)
Sign Date (MMID0,1TYP