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I�DIA\dSALESDISCLOSURF,FORd1 SDFID SDO(D 930761 Page2
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C Barrett
PreparerofNe Safa OBdosvre Form TiUe
226 VJest Broadway Broadway Title. Inc.
Addres(NumbQa�SVrey
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�E:SEI:LER $ GRANTOR 5 �z -': _ �w �:.. 1�.. �`cz3"..i`L; ��.- . ..`k;::.,3- . '�e.�.i`�`.,.,3L.-'?'tr,+'�",--=s c . a*:r� ''4�:.
Donnie W. Davis Patti L. Davis
Seller 1� A'ame ar appevrs on mm'ryann dxummt Sdfer 1� Name as appears w mnveyvnce dxument
3820 N 225 W 3820 N 225 W
Address (Numberand Arert) Addrrn (hbmber aMSrtretj
Patoka, IN 47666- Paroka. IN 47666-
Ciry.Smte. and LYl'ode Ciry.Smtt anAZIP Lodr
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Tele haneNUmber � - Ematl Tele MneNUmner E-mall
Under penal[ies of perjury, I here6y certify that [his Sales Disdosure to the best of my knowledge and belief, is true, wrrect
anjd �c lete as reqy�, red b law, and is prepared in accordance wi C 6-1.1-5.5, " al Property Sales Disclosure Act".
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�EBUI'ER S' GRANTEE S :-=.�APPCICATION:�FOR�PROPERTKTNi-0EDUCTIONS-_'dBENTIFYALCITEMS;THA'CABPLY -`. �
Michael J. Davis ShellyeA. Davis
Buy¢r 1� Name as aFpeurs w ronveyontt daummc Bvyv 2� Name as appears an romryan�e documrn[
2270 S 650 E 2270 S 650 E
AOEress(NUmberandSVeeQ Addnst(Numberand5veet)
Frandsco, IN 47649- Frandsco, IN 47649-
-mall Tdt fwneNvmber E-mail
THE 5,1LF5 OISCLOSVRE fORM MAY BE IISED TO APPLY FOR CERTAI.Y DEUIIRIONS FOR THIS PROPERTY. IDE.YTI{Y ALL OF THOSE THAT APPLY.
Y'FS NO WNDRION I ITION
x❑ � 1. Will this property be the buyer's primary �C `t 3. Homestead
residence? Provide complete address of primary 4. Solar Energy Fleating/Cooling Sysrem
resfdence,includingcounty: � �
3820 N 225 W S. Wind Power Device
ACdres(,YUmberand5veetf ❑ Q 6. Hydroeleciric Power Device .
Patoka, IN a7666 NOTAPPLICABLE � � 7. Geothermal Energy Heating/Cooling Device
Ciry.SmrcZIPCOEe Launry
��] 2. Does [he buyer have a homestead in Indiana to be � 0 $� �s ihis property a residential rental proper[}•?
��acated for this residence? If yes, provide ❑ � 9� Would you like m receive tax statements for this
complete address of residence being vacated, property via e-mail? (Provide conCact informo[ion
includi ecyunty: below.Pleaseseeinstrucdonsformoreinfarmation.
�Z� �� Nat avai(able in ail counpes.)
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Under penalties of perjury, 1 hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and comple[e as required y law, and is repared in accordance with IC 6-11-5.5, "Real Proper[y Sales Disclosure Act". (No[e:
Spouse in(ormari u1 n��Driver's License/Other numbers are not necessary if no Homestead Deductlon is
being filed.)
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