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INDIANA SALES L CLOSURE FORM SDF ID:
Paee 2
PREPARER :z. , +> `z ' ": s • : ' C�yfi :ri,, _ 15-
FD..
Patncia Kolb Closing Manager
Preparer of the Sales Disclosure Form Title
26 W Broadway_Broadway Title, Inc.
Address (Number and Street)
E. SELLERS GRANTOR(S),
Faith Annette Thomas
Seller1 Name as appears on conveyance document
474 White Oak Rrannh Rd
Selle r2 - Namensappearsonconveyancedocument
Address (Number and Street)
Statesville NC 28625
Address (Number and Streelf
Tele hone Number 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 comp as r quired by law, di prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ".
Sig I SignotureofSeller
tat o
iao D to MM DD Printed Nv o Seller Si n Date iMAa
GRANTE `= APPLICATIONTOR'PROPERTY T GTIONS= IDENTI L ITEMS THAT APPLY ='- d
renneth h mas
Patri 'a Ann Th mas
rson conveyance document
Buyv2 -Name asa nronveyance document
2692 S 1250 E
2692_S 1250 E
Address (Numberand Street)
Address (Number and5treet)
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THAT APPLY.
YES NO CONDITION YES NO CONDITION
✓ ❑ 1. Will this property be the buyer's primary
❑
❑ E] 3. Homestead
residence? Provide complete address of pr
gy Heating /Cooling System
residence, including county:
❑ 0 S. Wind Power Device
2692 S 1250 E
❑ [Z] 6. Hydroelectric Power Device
Address (Number and Street)
Oakland City. IN 47660 Gibson
❑ Q 7, Geothermal Energy Heating /Cooling Device
❑ ❑`/ 8. Is this property a residential rental property?
City, State ZIP Code County
❑ Q 2. Does the buyer have homestead in Indiana to be
a
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 counties))
/J� + / /�� 7 7
Address (Number and Street)
City. State ZIP Code County
Primary property owner can tact name E -mail
Under penalties of perjury, l 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 -S. S, "Real Prope ales Disc I sur Act ". (Note:
Spouse information, Socia Securi Driver's License /Other are not necessary i o omestead D uction is
rand
bein fled.) /
Signature ofBuyerl S' no a guyer2 /Spouse
_
Vie(. S S Icl Zr, O ill ZoiD