Homestead_PeachINDIA\A $ALES DISCLOSURF. FOR�I SDF ID SDO ID 936509 Page 2
D.PREPARER � � - � - - -
Samantha Cutsinger
Preyarer o/tht Sc/es Disrlosvre Form TiUe
226 W. Broativray Broadway Title. Inc.
AdJras(Nvm6eronASVeetJ Company
Princeton, IN 47670-
E. SELLER S GRANTOR 5
Jackie K Pollock Quinith S Pollock
Seiler ]- Name os opyevn m rwvryance J�wvment Seller I- Home os uppevrs on ronv�mmre dorurtrcm
354 S 180 E 354 5 780 E
Address (Number and SvreQ ACdrets (Numbrr anGSVeet)
Princeton, IN 47670- Princeton, IN 47670.
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Under penalties of perJury, 1 hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, corrett
and comple[e as require y law, and is prepared in a�cordance with IC 6-i.1-5.5, "Real Property Sales Disclosure Ac[".
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THE SALFS DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEOURIONS FOR THIS PROPERIY. IDENfIFI' ALL OF THOSE THAT APPLI'.
5'ES YO CONDITION Y
❑x ❑ 1. Will this property be [he buyer's primary x 3. Homestea
residence? Provide complete address of primary � � 4. Solar Energy Heating/Cooling System
residence,indudingcounty: ❑ �
624 S. STORMONT ST. 5. Wind Power Device
�Adress(NUmbrrandS[m[) ❑ Q 6. Hydroeleciric Power Device
Princeton, IN 47670 GIBSON � � 7. Geothermal Energy Heatlng/Cooling Device
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�� 2. Does the buyer have z homes[ead in Indiana m be � � 8. Is this property a residential rental property?
vacared for this residence? If yes, provide ❑ Q 9� �VOUId you like to receive [ax statements for this
mmpleie address of residence being vacated, property via e-mail? (Provide conmct in(ormorion
induding counry: below. Please see instructions for more in%rmatlon.
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A dd.ess (A'wnbe� and Sveet)
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Under penaltles of perjury, I hereby certify that this Sales Disclosure, [o the best o(my knowledge and belie(, is [rue, wrrec[
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 Deducaon is
�bein filed.) �
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