HomeMy WebLinkAboutHomestead_HaynesINDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
D.'F'fZEPARER `" � � � � � �. fr �
Kacv Shi�lev Closer
Preparer of the Sales Disclosure Form 75tle
607 W Jefferson St Meridian Title Corooration
Address (Number and Street) Campany
Plvmouth IN 46563
City, SW te, and Z(P Code Telephone Num6er E-mail
E: S�I.I;�R GRANTOR S � ` ��- �
Farlaral Natinnal Mnrfnana Asmr.iati�n �� Ka, E--�L�n n�`'e 1' �L
Se11er1 - Name as appears on conveyance document Seller2 - Name as appears on conveyance documen[
1d991 f)allac Parkwav Ste 1000
Address (Number and Street) Address (Number and StreetJ
I�allas, TX 752�i4
E•marl Te(e honeNumber E-mail
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my lrnowledge and belief, is true, correct
and mplete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
A�f� A 9 l iK ,� �� �?
Sig NreofSeller SignaNreofSeller
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Printed Name o Seller --r Si n Da[e MM DD Prtnted Name o Seller Si n Date MM 0
F. BUI'ER S GRANTEE S=APPLICATION:FOR'PROP-E�tTY TAX:DEDUCTIQNS :.IDE1�1'TIFY'ALI:ITEMS:�I�AT AFPLY; .., ., .,� ,`
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Dustin C Haynes ��/��Ms-rT�-c-t�
Buyer 1- Name as appears on conveyance documen t Buyer 2- Name as appears on con veyance dacumen t
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Address (Num6er and StreetJ Address (Num6er and Street)
k o �y�_�,5,; ; i�� z �► �( ��c�s
City, State, and ZIPCode Ciry, State, and ZIP Code
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E-mail Tele haneNumber E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCfI0N5 FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES � NO CONDITION
❑ 1. Will this property be the buyer's primary ❑ 3. Homestead
residence? Provide complete address of primary � � 4. Solar Energy Heating/Cooling System
residence, including county: � � 5, W�nd Power Device
�DQslf��,J. �'�j S .
Address(NumberandStree� �^ � [']� 6. Hydroelectric Power Device
17��x�n�v1� .1J�1 ���4 � l_'� �� � [� 7, Geothermal Energy Heating/Cooling Device
City,SW[eZ1P �ode County
❑ �2. Does the buyer have a homestead in Indiana to be � � 8• Is this property a residenrial rental property?
vacated for this residence? If yes, provide ❑ Q� 9. Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail? (Provide contact information
including county: be(ow. Please see instructions for more information.
Not available in all counties.)
Address (Num6er and S[reet)
a(�-►o-3( _�� -c�o �i��6
City, Sta[e ZIP Code County
Primary property owner contac[ n ame E•mail
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my laiowledge and belief, is true, correct
and compiete 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
bein led
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� N�n�✓ �n n..n C-n �.e'
T SignatureofBuyerl � SignatureofBuyer2/Spouse
n��ctin C HaynP� 11/30/2012
Printed
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Last 5 digiu of Buyer 1 Driver's State Last 5 Digits of Social5ecurity Number Last 5 digits af Buyer2/Spouse Driver's State Last 5 Digits ofSocial Security
License/ID/OtherNumber Number License/ID/OtherNumber