Homestead_DoernerDISCLOSURE
Rav M. Drulev Attomev No 4759-26 �
Preparer ofrhe5ola DBClosure Form Tth
505 N Church Street PO Box 146 Law Office of Rav M Drvlev
Addrea(NUm6erand5nee[) Company
Fort Branch IN 47648
flarenra V Barrett
Selfer7 - Nome as appmrs on tonveyvncedocvmml
40fi N Polk Streel
Addrest (Num6u an d Strer[)
Sel/er 2� Name os appmrs an ton�eyonce do�vmm[
dOfi N P Ik Ct eet
Addr¢ts (Number and Strttt)
FoA Alanrh IN 47fi4A Fnrt Ronrh IN 47[�q$
Ciry.
E�mall
lJnder penalties of perjury, l hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and co�te as required y law, and is prepared in accordance wi[h 1C 6-1.1•5.5, "Real Prop rty Sales Disclosure Act".
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THE SALFS DISCLOSUItE FORM MAY BE USEO TO APPLY FOR CERTAI\ OEDURIONS FOR
Q � 1. Will this property be the buyer's primary
residence? Provide complete address of �
residence, including county:
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AECrm's(NUmberandSOVet�
Fort 82nch IN 47668 Gibson
C�ry, sm�a v➢[ode Counry
� Q 2. Does the buyer have a homestead in Indiana to be
vaca[ed (or [his residence? If yes, provide
complete address of residence being vacated,
including courtty:
Addrets (Nvmber aiM Svret�
Cowry
\BUyer 2 - Name
Add a's(/Numd
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ronveyance
ENTM17ALr6F TNOSE THAT APPLY.
COYDRIOY
3. Homestead
4'Se} gy Hea[ing/Cooling System
5. Wind Power Device
6. Hydroelectric Power Device
7. Geothermal Energy Hea[ing/Cooling Device
8. Is this property a residencial renral property?
9. Would you like to receive tax statements for [his
property via e-mail? (Provide contact injormatian
below. Please see instructions jor more infarmadon.
Not available in all counties) _ �
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o..�.�...�. �.�.,..w�w�o mnmat name Email
Under penalties of perjury, t hereby certify that this Sates 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 6-1.1-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Drivers License/Other numbers are not necessary if no Homestead Deduction is
bein(� filed.) � �
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Number License/ID/OfherNumber