Homestead_Hayes (3)INDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
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Preparer o(lheSolc DiStlasure Farm Ti[le
06 Main St. Dubois Countv Title Co.. Inc.
Addr¢s (Numberand StreR) Company
Jasoer.IN 47546
H-mail
E:SEL'L:ER S GRANT,OR S. �.�_ x� *�>.x�� - �.:`.� i n.:'F x .�t°`i.� :-� c��=v . 9 t.-�,�.:`y� '
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The Fstate nf Wilma Lois Conner
Sdfer 1- Name as appmrs on ronvryance docvment Seller 2- Name as oppmrs on conveyance docvmmt
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Addras (Nvmber and Street) Addr¢s (Number and Svee[)
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Under penal[ies of perjury, 1 hereby certify [hat [his Sales Disclosure, to the best of my knowledge and belief, is true, correc[
and complete as required by law, and is prepared in accordance with IC 6-1.1-S.S, "Real Property Sales Disdosure Ac[".
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Randy L Conner.Pereonal Rep. 7-26-12
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F: BUYBR S GRANTEE 8-�APPL•ICATION�F,OR P.ROPERTY TAX:DEDUCTIONS=`:IDENTIF,Y-ALLaITEMS THATAPBLYr r:._?' _-�: �. '';
Caihv A. Hayes
Buyer 1- Name as oppmrs om m�vryance docvmen[ Bvyer 2- Nome as aypa�rs on ronveyance doavmmt
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Addras(Nvmberand Vett ' Address(Nvmbermd5treet)
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E-mail Te/e honeNumber E-mail
THE SALFS DISCLOSURE FORM MAV BE USED TO APPLY FOR CERTAIN DEDUCf10.�'S FOR THIS PROPERTY. IDENTI N ALL OF THOSE THAT APPLY.
YFS 10 COYDITIOH 1'FS YO CONDITION
� 1. Will this proper[y be the buyer's primary �❑ 3. Homestead
residence? Provide comple[e address of primary � �' 4. Solar Energy Heating/Cooling Sys[em
�.�� residence, including county:
� � S. Wind Power Device
Add�eu(NUmbe�ondSo-eeQ �±'-/_l� ❑ � 6. Hydroele[tric Power Device
V��� ❑ Q" 7. Geo[hermal Energy Heating/Cooling Device
Ciry. Smre Z1PCode Counry
� � 2. Does [he buyer have a homes[ead in Indiana [o be � � 8� �s this property a residential rental proper[y?
vaca[ed for this residence? If yes, provide ❑ s� 9• �/'�ould you like [o receive tau statemena for this
complete address of residence being vacated, proper[y via e-mail? (Provide rontad informodon
including munty: 6elow. Please see instrucdons far more information.
Not available in all coundes.)
Addras (Number and5tree[)
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[iry, Smte ZIP lodr Covnry
Pnmary properry owne�mnmR nome E-mall
Under penalties of perjury, I hereby certify [hat this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and comple[e 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 no[ necessary if no Homestead Deduction is
being fi
Sig oNrea Buyul SignamreofBUyeR/Spouse
LastSdigiuo(Buyer]Oriver's State LastSDigiuofSocial5ecunryNum6er Las[SdigiaojBuyer2/SpouseDriver's Smte GastSDigitsojSocial5ecuriry
License/ID/OrherNum6er Number Lirense/ID/OrherNumber