Homestead_AlveyINDIANA SALES DISCLOSURE FORM SDF ID: P e Z
as
D.PREPARER
of
Preparer of Me Sala Ditclot Form Tide
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Agdras [Number and Srreer) Company
-17 =:
C� ZlPCade Telephone Number E -mail
E. SELLERS GRANTOR S
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Seller I - Nam t appears an conveyance document
Seller 2- Name as appears an conveyance document
i1�R S. k�St. �_--.
Address (Number and Street)
Address (Number and StreetJ
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Ciry• Stall a ad ZIP Code 1
Cio•State and ZiPCode
E -mail
T Telephone Number 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 c9 plete as required by law, and is prepared in accordance 6.1.1• 5, 'Real Pr petty Sales Disclosure Act'.
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Signature of Seller uueof,S%ef r
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Printed Nameo Seller Si nDate MM DD 'nted Nameo Seller Stan Dow(MMIDDIYYYY1
F. BUYER(S)/GRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS- IDENTIFY ALL ITEMS THAT APPLY
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Buyerl - Name at &ears on conveyance docu
Buyer asy appears on conveyance document
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Address(Numberd
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an v
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Address (Number and Street)
City, Satq and ZIP Code -
Email I
Telephone Number E -mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
❑ 1. Will this property be the buyer's primary
❑ 3. Homestead
residence? Provide complete address of primary
❑ ® 4. Solar Energy Heating /Cooling System]/
residence, includi g county:
I Cv - �C >f j-C1 I � 1 .
!/
❑ [� S. Wind Power Device
❑ ® 6. Hydroelectric Power Device
nrye (xumb dS to
�; y-7
,c, �, 1y
❑ ® 7. Geothermal Energy Healing /Cooling Device
City, State ZIPCode County
El 2. Does the buyer have a homestead in Indiana to be
E] ® B• Is this property a residential rental property?
vacated for this residence? If yes, provide
❑ [a 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.)
Address(NumberandSaea)
City, State ZIP Code County
Primary property owner contact 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 Property Sales Disclosure Act". (Note:
Spouse Information, Social Security, and Drivers License /Other numbers are not necessary If no Homestead Deduction Is
bein flied.)
S(gnature ofBuyer�'°'l� �/ Signature ofBuyerZ /Spouse
Ti-Ir id � HI�.i1� /Jf. �1 -IBC`!
Printed Legal Name of Buyer Z /Spouse Sign Dare(MWOD/ryYY)
Lost 5TigithofBuyer ] vers State Last 5 Digits of5ocial Security Number Last S digits of Buyer Z /Spouse Drivers State Last 5 Digits of Social Security
License /ID /other Numb r Number License /ID /Other Number