HomeMy WebLinkAboutHomestead_GlotzbachIYDIA\A S.\LF,S DISCLOSUBF FORU SDY ID SDO ID 833478 Page 2
D.PREPARHR
Samantha Culsirger
Prryarer ojthe Scla Dudosvre Form 7itle
226 W. Broativ2y Broadway Title. Inc.
Address(NumLeronASUen) com� y
Princeton, IN 47674
E. SELLER S GRANTOR S
PaVick J Homrtuich
Sellei ]- h'ame oa op�won am m�rewnce Jrcument Sr/ler2 � Nume as appevn on ronvevunee dwument
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Addrese /Numfxr ond SmeeQ AdErm (A'umber and5:reeQ
Ft. Branch, IN 4764&
E-muil Tele meNumbrr E-moll
Under penalties o(perjury, I hereby certi(y that this Sales Disclosure, to [he best o(my knowledge and belief, is true, corred
an�mple e as requ' ed b� d is prepared in accordance with IC 6-11-5.5, "Real Property Sales Disclosure Act".
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Signarure of ' Signemrz aJSclfer
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F.BUYER 5 GRANTEE S -APPLICATIONFOR�PROPERTYTAXDEDUCTIONS-�IDENTIFYALLITEMSTHATAPPLY
Amanda Gloizbach
Bvyer i� A'omr ns oppeers on ronvevanre Javmen: Buyer? � A'ame as appevrs m mnveynnce dotumen[
705 W. JoM St.
ACdress (Number anJSver[/ Addrm (NUmber andSneetJ
Ft. Brench, IN 4764&
�Ciry. Smtt. anE ZIPCMe Ciry, Sm[e, and ZIP CoCe
YSFORTHISPROPERTY_I ' LOFTHOSETNATAPPLY.
YES VO COYOITION I i NO CONDITION
x0 ❑ 1. Will this properry be the buyer's primary x � 3. Home �
residence? Provide complete address of primary � Q q, Solar Energy lieating/Cooling Sys[em
residence, in�luding couniy: ❑ �
203 E. SOUTH ST. 5. 4Vind Power Device
Address(NUmleronOSnreq ❑ Q 6. Hydroelectric Power Device
Ft. Branch. IN a7648 NOTAPPLICABLE � � 7, Geothermal F.nergy Heatlng/Cooling Device
Gry; Smte 21P Code Connry
❑�] 2. Does the buyer have a homestead in Indiana to be � �$� �s this property a residential rental property?
vacated for this residence? If yes, provide ❑ Q 9� �Vould you like to receive tac statements for this
complete address of residence being vacated, properry via e-mail? (Provide contact information
induding county: be7ow. Pfensesee instrucponsfor more in%rmation.
Not available in afl counties.)
Addre�s /NUmber and Strrel)
� �-i9-19- �03-bao.(�a3-ad�
Cir�.Smre Z1PCode Counry
Pnmaryproperry oumo wr.�ac! nvme E-maii
Under penaltles of perjury, I hereby certify that this Sales 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-S.S, "Real Property Sales Disclosure Ac[". (No[e:
Spouse informa[ion, Social Securiry and Driver's License/0[her numbers are not necessary if no Homes[ead Deductlon is
being filed.)
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License/ID/OtherNumber Number License/ID/O[herNumher