Homestead_Green (2)DEC-7-2012 02:32P FROM:GIBSDN COUNTY RSSESS 612 386 6757 T0:7493976 P.3�5
Pseparcr o/Ne SvNS D4dosun Form 77tl�
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Ad eu(KuroSerandStrer[J
E-mall
�on<onveyvnceCOCVmm
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5'litR � Namt ¢t appears on conve}ance au[ument
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�,1 hereby certify that thls Sales Disclasure, to the best of my knowledge and belief, is true, correct
by law, and Is prepared in accordance with I�� 6•1.1-5.5, "Real Property Sales Disclosure Act".
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ALL
Bvyer 2� Name m appeax om m�veyann doeumen[
Addreu (Number ond Sveet)
pb. Smte, and ZIP Lode
TME SA1.6 UISCIA5tiR2 FONM M�Y B8115ED TO APPLY FOR �RTNY DEDURIONS FOR TIIS PROPEATY.
� 1.Willthisproper[ybethebuyer's
residence? Provide complete adi
residence, including county:
.4Ednn(HUnW anlSmefJ -
qry.SmteZIP e Counry
� � Does the buyer have a homestead in Indiana to be
vacated for this residence? Ifyes, provide
complete address of residence 6eing vacated,
including county:
Addrw [NumDrr cnd StreetJ
Gry. Smu ZIP Code [ounry
❑ 3.
ALL OF THUSH THAT APPLY.
Heatlng/Cooling System
❑ [� 5. Wind Power Device
❑ e� 6. Hydroelectric Power Device
� � 7, Geothermal Energy Heatlng/Cooling Device
❑ [.� 8. Is this property a residentlal renWl praperty7
� ��9. Would you like to receive wc statements for this
property via e-mail? (Provide contact informacion
below. Please see instructlons jar more informadon.
Not avai7a61e in all coundes)
�� .� /.�_a� -/o�-000. �95� ooY -
Under penalties of perjury, I hereby cert(fy that this Sales Dlsclosure, to the best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance wf[h IC 6-1.1-5.5, "Real Property Sales Disc)asure Act". (Nnte:
Spouse infarmadon, Soclal Securlty and Driver's License/Other num6ers are not necessary if no Homestead Deduttion Is
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Slgnob�/BVyer] � Stgnamrro/Buyrrl/Spouse
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I Las[SJigiao/Buyer2/SpouseDrivers Smm LastSDlgitsofSxlalSecudry
Licenre/ID/OrherMum6er Num6er License/ID/O[herNumber