Homestead_Wilkerson (3)I,CDIANASALESDISCLOSUREFORV SDFID SDOID 1387983 Page2
D.PREPARGR
Samantha Cutsirger
Preyarer o/the Scles 06dasure Form Ttle
226 W. Broadway Broadway Title, Inc.
Add�m (NumLer and Surat) Company
Princeton, IN 47670-
E.SELLER S GRANTOR S
Mary �ou Ross by Jayme Delnay, attomey-in-fact
Seller 1- Name osopyrvn w mnvnnme duument SrllerZ - Nume os nppeors om m�veyun<e da�vmen�
��d y,00 ,eo�k aay �,�.
Address (Number ond SveeQ Addrtss (A'vmbrrand5vee[]
Louisville, KY 4gYC.t �`0 2`f s
Ci.y, Smt4 an✓LIP CnJe Gry, Smtc, nnAZIP Cade
E-muil Tde honeNumbr. E-mnil
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 aceordance with IC 6-11-5.5, "Real Property Sales Disclosure Act".
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F. ERS GRANTE S -APPLICATIONFORPROPERTYTAXDEDUCTIONS-1DENTIFYALLITEMSTHATAPPLY
rolMn Wilkerson
B� ��Namensa oonveyan[edavmen: Buyer2�Nameosappnrsamm�veyunceEatvmmt
3038 S 700 W
Addres (A'um.ber andSem[J dddres /Numbrr and SvceQ
Owensville. IN 47665-
Ciry.Stnh. and ZIPCade pry. Sta�e, end 21P Code
E�mail Tde hmeNUrnber f�moil
THE SALFS DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN UEUUCfI0Y5 i0fl THIS PROPERTY. IDENTIFI' ALL OF THOSE THAT APPLY.
YES 80 CO.VDITION I\'FS NO
x0 ❑ 1. Will this properry be the buyer's primary Q 3. Homesread
residence? Provide mmplete address of primary , nergy Fleating/Cooling System
residence, including county: ind Power Device
210 N. MAIN ST. � �
AdAress(NUmbrrandStrxQ ❑ � 6. Hydroelectric Power Device
Ov+ensville, IN 47665 GIBSON � � 7, Geothermal Energy Heatlng/Cooling Device
Ciry, Smce ZIP CoCe Counry
�� 2. Does the buper have a homestead in Indiana [o be � � 8• �s this propem� a residentiai rental property?
vacated for this residence? If yes, provide ❑ � 9� �Vould you like [o receive tax statements for this
mmplete address of residence being vacated, property via e-mail? (Provide contact in/'ormation
induding munty: below. Please see instructlons%r more in%rmation.
Not avaifable in all rounties.)
Addresz/Num6r�ar.d5uee�) � /��j // /�ao.
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Ciry, Smm ZIPCode Counry
Ynmaryproperry o�vnei ror.mtt name 6'-mail
Under penalties o( perjury, I hereby certify tha[ [his Sales Disclosure, to the bes[ o(my knowledge and belief, is [rue, 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 i(no Homestead Deducdon is
being filed.) p
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Pnntedle,9alNomeofBUyerl Si4nDO:�� Pnnfedl.eqalNan�eo(Bvperl/Spouse AgnDa[rlN.u/DO�'t'n'1
los.5digiaofBu}•erlDriver's 5[ate LastSDlgitso(SocialSetunryNum6er I,astSdigiGSO(Buye�2/SpouseDnver's Smre Last50igiao(SonclSecunry
License/ID/Othe�Numbe� Number Litense/lD/O�henVUmber
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