HomeMy WebLinkAboutHomestead_BlackbumI\DUNdSdLESDISCLOSUREFOR\t SDFID SDOID 1266556 pag�Z
:D:�.P.REPARER � � '�r ,��_�.,� �.,-,�''�_-"`�- i'��:a ,t�._:-=t `'`" c C�.,=' �t;'��.s�,� '^..�v:F°-.3.
KimbeAyA. Lewis Office Manager
Prtparerofthe5alesDiulosureFOrm 77Ue
226 W. Broadway Broadway Title, Inc.
Addreu(AbmberondSbeer) Company
Princetan, IN 47670-
'�E:'SEI:L'ER S � GRi1NTOR S `=.�'�t,�"�'�-z—�:r o '.:._€i' ?� e,'.�.yt':y" x,Y-., :Sr,.s .� :.r.srfd".. .i;:�. ,�� ,�.—�-a, f r.� � e . �t
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Thomas T. Higa Peggy L. Higa
Seller I- N�me as oppean om m�veyvnce doaument Sel/e� Z� Name us appevrs on mrtveyanm Javment
9730 W. State Rd. 765 9730 W. State Rd. 765
Addrezf lNum6erandSRert) Mdrcn(NumberundSReet)
Owensville, IN 47665 Owensville, IN 47665-
Ciry, Smte, and7lPCode Cig; Smlc, and LPCode /j
E-ma17 Tele honeNUmber g�p
Under penaltles of perjury, l hereby cerdfy tha[ this Sales Disclosure, [o [he bes[ of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in actordance with iC 1-5.5, "Real Property Sales Disclosure Act".
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TEE S �_APP:GIGATION�FORP.ROPERT.YTA}C`DEDUCTIONS`�IDENTIF.YAGCiTEMSTHAT,-APPLY " - -���
Damon Blackbum Melissa Bladcbum
Buya �, ,. � onmm�vncedaaument Buyerl�Nameasappearsonwnveyonredocumm[
306 S. Spring Si. 306 S. Spring St.
Addrea(NumberandSoxrQ Addrev(Num�erand5n2<Q
Princeton, IN 47670- Princeton, IN 47670.
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THE S.LLES DISCLOSURE FORM h1AY 6E USED TO APPLY FOR CERTAIN OEDULTIOYS FOP THIS PROPERTY. IDEhTIFY ALL OF THOSE THAT APPLY.
YFS NO COYDITION NO CON�ffIO�
❑x ❑ 1. Will this property he the buyer's primary ❑x � 3. Homestead
residence? Provide complete address of prima 4. o ar nergy Heating/Cooling Sys[em
residence, including county: � � 5. Wind Power Devite
9730 W STATE RD. 165
Addreu(KUmbua�d5trnq � Q 6. Hydroelettric Power Device
Owensville, IN 47665 GIBSON � � 7, Geo[hermal.Energy Hearing/Cooling Device
Gry,Smte2lPCode Covnry
�� 2. Does the buyer have a homestead in Indiana to be � Q S. Is this property a residential renial property?
vaca[ed For [his residence? If yes, provide ❑ 0 9. Would you like to receive [ax s[aiements for this
complete address of residenre being vacated, property via e-mail? (Provide contact information
including county: below. Please see instructions for more information.
Address (Num ber arM Svret)
Ciry,SmhZlPCade lounry � O� _� DO— OOO• ,l� ' O�/
� � mail
Under penalties of perjury, 1 hereby certify that this Sales Disdosure, to the best of my knowledge and belief, is true, correct
and [omplete as required by law, and is prepared in acrordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's Litense/Other numbers are no[ necessary if no Homestead Deduttion Is
being filed.) �n '� / r �,2n �,p
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Sjqnatvreo/Buyerl /� Signvm�e `(Buyer2/Sponuse1 v` /?
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Gnncedl alNameaJBuyerl SignDafe(MX/OD/YYfI] pnnttdLlgalNamPaf$uyP2/$pOYS¢ �
LastSdigiuo%BuyertDriver's Smte LasCSDigiGSOfSocialSecusiryNumber LnstSdigiGro%Buyer2/SpouseDriver's Smte Las[SD(qicso%SocialSecunty
Ltcense/10/OtherNumber Number L(cense/(D/OtherNumber