Homestead_HalsteadFORM
Preparer o(the5ala Oiulmure Fortn
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Add NumbeiandStreee)
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City.Sm[GmdZIPCade �
Seller
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Titl
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Compvny
E�mail
Seller2� ameasappmrsanronveyancedacumrnt
,D, �o;� ��105 3
.tddras(Numberond5tree[)
3 �'vuhs;;file. �/ y��3� - 3�s3
City.Sm[4andl/PCOde �
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Under penalties of perjury, I hereby cer[ify [ha[ [his Sales Disclosure, to the best of my knowledge and belief, is true, correct
and com as required y law, and is prepared in accordance wi[h IC 6-11-S.S, "Real Property Sa s Disclosure Act".
� � ' ���. Cti� �G � �-��,�-
Signat eo(SrJler '' �/ Signam�eo(Seller
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TNE SALES DISCLOSURH FORA1 MAi' BE USED TO APPLY FOR CERTAIti DEDUCf10N5 FOR
Q' � 1. Will this property be [he buyer's prim
residence? Provide complete address
residence, induding county:
nde.�: �n�mee� o�d snre��
Ciry, Smte ZIPCode Counry
� �l�' 2. Does [he buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
comple[e address of residence being vacated,
including county:
Addres (Nvmber andStrrer)
Ciry. Smte 2/P lade
LounN
THATAPPLY
Buyv2 � Name as appmrs om m�veyanre docvmen[
Addras (NUmber an d Strcel)
Ciry, Smt4 a�d Z/PCOde
Q � 3. Homestead
rgy Hea[ing/Cooling Sys[em
� �' S. Wind Power Device
❑ Q' 6. Hydroelectric Power Device
❑ o- 7. Geo[hermal Energy Heating/Cooling Device
� � 8. Is this property a residentlal rental property?
❑ [i} 9. Would you like to receive [ae statements for [his
property via e-mail? (Provide contact informotlon
6elaw. Please see instructians for more in%rmation.
Not available in all counties.)
o?G-����- ��-�av.�96-c��
PnmarvorouerNOwnercon[octnome E�mail
Under penalties of pery'ury, I hereby certify tha[ this Sales Disclosure, to the best of my knowledge and belief, is true, correc[
and comple[e as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disdosure Ac[". (No[e:
Spouse informa[ion, Social Security and Driver's License/Other numbers are not necessary if no Homes[ead Deduc[ion is
being filed.)
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