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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
!O?P.REPARER "lull
Preparer tithe Sofa Disclosure
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Er SELLER(S)/G RANTOR(Sf," J;
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Selle�- as ax n7d, ent
Selle,2 N.nw., ve,unce document
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Address, (NuenbecludSodet)
: Ll 72 3�)S -3
Address (Number and Streer)
Ll 7 3 S-- 36,_�_ 3
tf_L/e7 n 51) 1
City, State and ZIP Cod
Telephone Number Email
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 cornp�[�eas required by law, and is prepared in accordance with. IC - 1.1 -5.5, "Real Disclosure Act".
,�PSales
of Seller Signature of Seller
X4e ID-1 Johnson �Va,17dq M, To fA -Son
Print S�n D, .MY) Pdatedllanw.� Sfan Date [MMIDDIYYYY)
,F,B14k�/GRANTEE(S) APPLICATIONIFO M�ERTYiTAXT EDUCTI ONS-'l DENT] FY:AU-ITRISyTHA4APPLY7'7
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Buyer 2- Name as appeals on mm,eyance document
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F? ?7 1L
F? 7 Ll 16 o
Address (Number and Street)
I ki U/ / � •
Telephone Number E-moil
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
U' F-1 1. Will this property be the buyer's primary
❑ 3. Homestead
residence? Provide complete address of primary
❑ a 4. Solar Energy Heating/Cooling System
residence, including county:
42 10 W.
❑ a S. Wind Power Device
❑ 2� 6. Hydroelectric Power Device
0;=bE on
47 /"0 aid
1�iv 4 50A)
❑ Er 7, Geothermal Energy Heating /Cooling Device
8. Is this property a residential rental property?
City, State ZIP Code County
❑ 2' 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 e-mail? (Provide contact information
including county:
below. Please see instructions for more information.
Not available in all counties.)
G-W -1 CP00 7
Address (Number and Street)
City, Slow ZIP Code County I
Primary propertyinotter contact name Email
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 Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
bei filed.)
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jn,mr( Signature afguy�21SIouw
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Printed Legal Rome afBayer I Sign Dow LMMIDD/Yrff) Pd. led Legal Name fBaye, 2 /Spouse Sign DvmLMM1DD1nYYJ
Lu.,t5digiuqfDuycrI Driver's State L t5oitsofSocialSecuri -Number L.st5digiaofgu3vr2,'SpousoL)rit-or'E Slats LartSDigirsofSocialSecurity
LicensellDlOther Number Number License /ID /Other Number
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