HomeMy WebLinkAboutHomestead_CulbertsonINDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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Ray M. Druley Attorney No. 4759 -26
Preparer ofthe Sales Disclosure Form Title
15 N. Church Street. P.O. Box 146 Law Office of Ray Druley
ddreu(Number and Street) Company
Fort Branch, IN 47648
City, State, and ZIP Code Telephone Number Email
,E.- SELLER S' GRANTORS ,
Catherine Flaine Marshall
Peppy Ann Cnndiff
Seller I - Name as appears on conveyance document
233 Humphrey Rd
Seller 2 - Name as appears on conveyance document
336 River Forest Parkway
Address (Number and Streef)
_ Lynnville. IN 47619
Address (Number and Street)
.Ieffersonvilla IN 47130
City, State, and ZIPCode
City, Stow, and ZIPCode
E -mail
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and mplete as required by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ".
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Signature of Seller Signature of Seller
Catherine Elaine Marshall October 5- 2010 Peggy Ann Cundiff October 5 2010
Printed Name o Seller St aDow (MM D Printed Name o Seller Si nDate MMIDD
i'F. ^.BUYERS GRANTEE S i-: APP.L,ICATION.,EOR'PROPERTY,TAX DEDUCTIONS= 'IDENTIFY•AL'L ITEMS THARAPP.LY;`
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Bu 2- Nameas appears on ropy nce docu ent
Bu r1 -Name as appears on ronveya edacument
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w Tel o r a te
Address Num
411 k
rand Str ee
Address Number
and Street
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THE SALES DISCLOSURE FORM MAY RE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
Q ❑ 1. Will this property be the buyer's primary
❑✓ ❑ 3. Homestead
residence? Provide complete address of primary
❑ [Z] 4. Solar Energy Heating /Cooling System
residence, i eluding county:
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❑ ❑✓ 5. Wind Power Device
3�6 W t ���^ h
❑ ❑d 6. Hydroelectric Power Device
❑ Q 7. Geothermal Energy Heating /Cooling Device
❑ ❑� 8. Is this property a residential rental property?
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City taw ZlPCode � County
❑ 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
❑ ❑✓ 9. Would you like to receive tax statements for this
complete address of residence being vacated,
property via a -mail? (Provide contact information
below. Please see instructlansfor more information.
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12.1 includin�counl:�Z
1-�
Not available in all counties.)
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dress (Number an Street) �^ L
Pl2 f e r.s u rG IN 17567 l� r Ugh
City. Smte ZIPCode
County
Primary property owner contact name E -mail
Under penalties 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 -5.5, "Real Property Sales Disclosure Act ". (Note:
Spouse information, Social Sec city and Driver's License /Other numbers are not necessary if no Homestead Deduction is
bein 1 d. n
' Signature o Buyer2 use
Sjgnamre of8 1 n f /S!" Jj�
-� lya r (,u�ber Ortnher5 2010
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Printed
Security
License /ID 10ther Number Number License11010ther Number
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