Homestead_Robling (3)I\DL4NASALES DISCLOSURE FOR�I SDFID SDO ID 1383979 Page 2
.D.PREBARER< - - - — - - =- - - - -
KimbeAyA. Lewis Office Manager
Yreparerofthe SalrtOurlwure Form IFtle
226 W. Broadway Broadwav Tiile Inc.
Addren�Nvn6erondSu¢et) Company
Princeton, IN 47670- 872-386-1687 kim-bti@insightbb.com
Ciry, Sm[e, andZlPCode TelepM1one Number £-mail
.E.SELLER S GRr1NT0R S � - `.- . ••��, `. - ,-7. : � ' - - : +� -. - c_ _.•-; ..`';;�:� �.
Shawn S. Shouliz Amber R. Shoultz
Selfer ]- Nume os apywrs on mmryvnre daumen[ Seller2 - Nvme as uppeursam m�reynnce Jxumrn[
4454 N. State Rd. 65 4454 N. State Rd. 65
Addrtu(NUmberandSnee[J AAdress(Numberond5beet)
Patoka,IN 47666- Patoka,�N 47666-
Under penal[ies of pery'ury, l hereby certify that [his Sales Disclosure, [o the bes[ of my knowledge and belief, is true, wrrec[
and complete as required by law, d Is prepared in accordance �vi[h IC 6-1.1•5.5, "Real Property Sal s Disdosure Act".
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F.'BUYER S GRANTEE S-APPLICATION FOR PROPERTY.TAX DEDUCTIONS-.IDENTIF,Y°ACL ITEMS'THAT APPGY_ `::- �.. -
ZackaryA. Robling
Buyer i� Name as vppears om m�ve�vnce Daeument Ruyer Z- Name us appmrsom m�veyanre dxumm[
5998 W 200 N
Addrea (Num6e�and SmerrJ Addras (�YVmberand S[reet)
Patoka,IN 47666-
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THE SAI.ES DISROSURE iORN h1AV 6E USED TO APPL1' FOR CERT;IN DEDUCf10N5 F00. THIS PROPEftIY. IUEhTIF1' ALL OF THOSE THAT APPLY.
1'FS NO C0101TION VES NO CON�ITIOY
x� � 1. 4Vill this property be the buyer's primary ❑X ❑ 3. Homestead
residence? Provide compleie address of primary � � q. Solar Energy Heating/Cooling System
residence, including county: � �
4454 N. STATE RD.65 S. Wind Power Device
Address(RUmberardSmQ ❑ Q 6. Hydroelectric Po�ver Device
Patoka, IN a7666 GIBSON � � y. Geo[hermal Energy Hearing/Cooling Device
Ciry. Smce ZIP Code Caunry
�� 2. Does the buyer have a homestead in Indiana to be � 0 8� �s Ihis property a residential rental property?
vacated for this residence? If yes. provide ❑ � 9. \Uould you like [o receive [ax s[atements for this
complete address of residence heing vacated, property via e-maiR (Provide contoct information
induding county: below. Please see instructions for more in(ormation.
Not availa6le in alf munties.)
Addrcss (Kumbe� and SvreQ
Ciry.SmleZlPCode Caunry � �_� � �� _,OG OOO � � � O/ �
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