Homestead_Harper (3)INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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Ray M. Druley Attorney No. 4759 -26
Preparer of the Sales Disdasure Form Title
05 N. Church Street, P.O. Box 146 Law Office of Ray M. Druley
Address (Number and Street) Company
Fort Branch, IN 47648
Ernest Ray Hamer
Seller I - Name as appears on conveyance document
322 S- Gihsnn
Seller 2 - Name as appears on conveyance document
Address (Numberand Street)
ORkland City- IN 47660
Address (Number and Street)
City, SW be, and ZIP Code
City, State, and ZIP Code
E -mall
Telephone Number 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 requRV by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ".
ignamre of Seller ( Signature ofShcer
'
Ernest Ray Hamer 219919011
Printed Name o Seller Sin Date (MM D Printed A'amea r S! n Date (MM D
- ATIONIF, ORi PROP.ERT,Y:TAXiDEDUCTIONS ="IDEN , �AI:LLITEMS:THAT,APP.L'Y-,V;1
nd
Buyer l- Name as appears on wnv
Buyer Z - Name as oplkVizrs
an onvevance docent u
ain treet
Address (Number and Street)
Address (Number and Street)
Citv IN 47660
�7akland
E -mail I
Tele hone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR TH
[DENT] T APPLY.
YES NO CONDITION
1. Will this property be the buyer's primary
residence? Provide complete address of primary
ng /Cooling System
residence, including county:
❑ Q 5. Wind Power Device
.1 �'� I 1 �.L
1
❑ d❑ 6. Hydroelectric Power Device
Ad ess(a rand-SS° -�s`}�
,
I (a i11 r51
I t \i. �� � O 6 r
❑ ❑J 7. Geothermal Energy Heating /Cooling Device
❑ ❑ 8. Is this property a residential rental property?
City, State ZIPCode County
E] F,71 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
❑ [Z] 9. Would you like to receive tax statements for this
complete address of residence being vacated,
property via e-mail? (Provide contact information
below. Please see instructions for more information.
including county:
Not available in all counties.)
^ (_ I [ ( ' F Q a -
Address (Number and Street)
Ciry, Smte ZIPCade County
Primary property owner mnmctname E -mail
Under penalties of perjury, l 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:
Spous information, Social Security and Driver's License /Other numbers are not necessary if no Homestead Deduction is
beln f ad.) / I
1 t PIXEL C "
SlgnotureofBuyerl SignatureofBuyrr2/Spouse
®nnnd- 1 Condpr 2122111
Sign Date(MM/DD/vrrY)
Last 5 digits of Buyer 2 1Spouse Driver's State Last 5 Digits of Social Secunry
license /ID /Other Number Number License /I0/0ther Number