Homestead_JinesINDIANA SALES DISCLOSURE FORM / snF In-
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Rav M. Drulev Attomev No. 4759 -26
• Prepares ofthe Sala Disclosure Form lade
-05 N. Church Street P.O. Box 146 Law Office of Ray M. Drulev
Addrar(Numberand5treet) Company
Fort Branch. IN 47648
SELLERS r:GRANT.OR S34T'�t'r? al`1_�t
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M K Pornrrtips Inc
Seller 1 - Name as appears on conveyance document
P.O. Rox 176
Seller Z - Name as appears on conveyance document
Address (Number and Street)
White Oakrls TX
Address (Number and Street)
City, State and ZIP Code
Telephone Number Email
I 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 required by law, an pr ared in accordance with IC 6- 1.1 -5.S, "Real Property Sales Disclosure Act ".
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SignmureofSeller Signature of Seller
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M.K. Prnnertiec Inc '/ 11 - ;W /i7
Panted Na er Si nDate(MM/DD Printed Name o Seller Sin Dow (MM D
YER S r,GRANT e' APP: I: ICA1' IONIFORPROPERTrY4TTKXDED UCTIONS`-_ �' IbENTIF Y!ALIfITEMS:THATd'APPLY:r
Buyer l - Name as appears an veyance document
Buyer 2. Name as appears on conveyance document
Address NumberandStreet)
Address (Number and Street)
Petersbur h IN 47567
,
E -mail I
Telephone Number E -mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
NO CONDITION I YES NO CONDITION
al
❑ 1. Will this property be the buyer's primary
9 ❑ 3. Homestead
residence? Provide complete address of primary
❑ � 4. Solar Energy Heating /Cooling System
residence, including county:
❑ ❑✓ S. Wind
, N L •1 N S fi-
Power Device
❑ ❑✓ 6. Hydroelectric Power Device
AdAr.. fmM„ ,and5treet) // pv�
_ Un 1: Code C i i'Y � ��� { ?L G' i �7`x! { "I
City rate ZlPCode
❑ ❑ 7, Geothermal Energy Heating /Cooling Device
County
❑ 2. Does the buyer have a homestead in Indiana to be
❑ ❑✓ B. Is this property a residential rental property?
vacated for this residence? If yes, provide
❑ R] 9. Would you like to receive tax statements for this
complete address of residence being vacated,
property via e-mail? (Provide contact information
in county:
below. Please see instructions for more information.
z g y y A r Od S
Not available in all counties.)
_�a n
dressd5treet,
City. State ZIP Code T County
/ I
Primaryproperty owner concoct 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 Security and Driver's License /Other numbers are not necessary if no Homestead Deduction is
being filed.)
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Signatare ofBayerl Signature ofBeyer2/3pouse
2
Mn Legal NameofBuyerl Ig Dme(AMIDDIY" Aimed Lego]Nome of Buyer 215pouse Sign Dow(MMIDD/rvn)
Last 5 digits of Buyer l Driver's State Last 5 Digits of Social Security Number Last 5 digits ofBuyer2 /Spouse Drivers State Last 5 Digits afSocial Security
License /ID /Other Number Number License /ID 10ther Number