Homestead_DurhamINDIANA
DON DOWELL CLOSER
Preparero(NeSaluDisdosure Form Ttle
11 HWY 66 FIRST ADVANTAGE TITLE LLC
�dCres (A'umber and5nee[) Compony
NENBURGH IN 47630
cH�� y� /vr�N
Sel/er ]- Name as appearson conveyunce dxummt
C�s�l 6 w '�oa S
Addrm (Num6er ond5rreey
OWE,vSvrc�c,E � �N L%7ld S
Ciry, Slvte, and Zf➢COde
Sel1u 2- Name ar appears on cwveynnre documen[
Addr� (Number
Ciry; Smce, and7JPCode
Lf3 "..
Under penalpes of perjury, I hereby certify that this Sales Disclosure, ta [he best of my Imowledge and belief, is true, correct
and co I[e as requ�red b law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
�� ���
Sgnamreo( !er ! � � ^ SignolureoJSeller
N
Yumberan StreeQ V /! k
ncG cst�i TN Y��t�U
�
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIY
,[1� ❑ 1. Will this property be the buyer's primar}�
residence? Provide comple[e address of primary
residence, including county:
(oSN� w yoo S
Addr� (NUmbe� and Street)
OwEn,svl��e �n, �/7665 �IKSON
Ciry,SmcevPCoee � Counry
� ❑ 2. Does [he buyer have a homestead in Indiana to be
vaca[edforthisresidence? Ifyes,provide
comple[e address of residence being vacated,
including county:
dddres(Numberand5veeq
[iry, 5mfe ZIPCOde Cowry
Buyer 2- Name as appears on conveyance dxument
Addrea (Number und S[reet)
Ciry. Sfare. and7JPCOde
Tele E-mail
ISPR PERTY. I�ENTIFYALLO ETNATAPPLY.
YFS NO CONDITION
❑ 3. Homestead
� t�' 4 Snl � eating/CoolingSystem
� �
■ �
� �
� ��
■ G/
5. Wind Power Device
6. Hydroelec[ric Power Device
7. Geo[hermal Energy Hea[ing/Cooling Device
8. Is [his properry a residential rental property?
9. Would you like to receive tac statemencs for this
property via e-mail? (Provide con[ac[in%rmation
below. Please see instructions for more informadon.
Not availa6le in all countles.)
Z�'/b 36- /D/-oo5� /q/a�
Gdmarv OmoerN aWllelCOnW([ nam! e-l11011
Under penalties of perjury, I hereby certify tha[ this 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 6-11-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are no[ necessary if no Homestead Deduction is
�AtvN`f� �vRNan p3/2r l�Z
'nhred Legal Nameo(Buyer 1 S(qn Da (M1VD
(
LastSdigittofBuyerlDriver's Smte LastSDigirso%SocialSecunryNum6er
License/10/0[her Num6er
Signature ofeuyerl/Spouse
PnntedLegalNameofBUyer2/Spouse SlgnOa�e(uH/DO/YYYh
Las[SdigiGSO%8uyer2/SpouseDriver's Sm[e Las[SDigiao(Sociol5ecuriry
Num6er License/lD/OtherNumber