HomeMy WebLinkAboutHomestead_KennedyI�DIANASALES DISCLOSURE FORJI SDFID $DOID 1389371 Page2
D.PREPAR6R � - � �
Samantha Cutsinger
Preyorer ofthe Sc(rs Oisdomre Form TiUe
226 W. Broadway Broadway Title, Inc.
Addrns(Num6erarMSveetJ Compony
Princeton, IN 47670.
E.SELLER S GRANTOR S
Donnie E Drake Salry J Drake
Srller ]- Name � apyevn m mnveyvurce J�KUment Srllo� 2- Nume as upyevn"um m�vexin<e dorurnen�
9837 W 575 S 9837 W 575 S
Adarese (Number ond5[rrer] ACdrtss (NUmberonC Saee[%
O.vensville, IN 47665 Owensville, IN 47665
E-mail Tele honeNUmbe. f-moil
nder penalties o e'ury, 1 hereby [ify that this Sales Disdosure, [o the best of my knowledge and belief, is true, correct
complete as re u'r� by law, an 's prepared in accordance with I 1.1-/5.5/, ,"�R,e�al P,ropert}�Sales Disclosure Act".
...... 1� -` ��`�"'`"�'-� l. ��. ��
SignveoreofShcn �namrra Sclfer �
Donn��� E. I�rak� /z/�z�2��Z a�� J. Qrake �Z�iz�ao�z
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F. BUYER 5 GRANTEE S- APPLICATION FOR PROPERTYTAX DEDUCTIONS- IDENTIEY ALL ITEMSTHATAPPLY
Derek T Kennetly
Bu)r� 1- M1'ame rts aA�rs am m�veyvnre Aatvmnv Buyer 2� Name as apprars an ronvrynnre dorument
R.R. 2, Box 150A
Address(KumbrrandStreetJ Addass(,YUmberondStrn�)
Dahlgren, IL 6282&
ag. sm<e. o�e nr exe e�y, smre o�e nv eoee
E�moil ide honeNumber E-moil
TNESALFSDISCLOSU0.EFORMMAYBEIISEDTOAPPLYFORCERTAINDEDULTIONSFORTHISPROP LOFTNOSETHATAPPLI'.
YES VO [OVDITION YES NO CONDITION
❑x ❑ 1. Will Chis property be the buyer'S primary x 3. Homestead
residence? Provide complete address of primary � � 4, Solar L'nergy lieating/Cooling System
residence, including councy:
9837 W 575 S ❑ Q 5. Wind Power Device
Add�ess(NUmbrrondSrveeQ ❑ Q 6. Hydroelectric Power Device
Owensville. IN a7665 GIBSON � � 7, Geothermal Energy Heating/Cooling Device
Ci9t Smce ZIPCOCe Counry
� � 2. Does the buyer have a homestead in Indiana m be � Q $� Is this properry a resideniial rental propercy?
vacared for this residence? If yes, provide ❑ Q 9� Would you like [o receive [ax statements for this
complere address of residence being vacated, propercy via e-mail? (Provide contact in(ormouon
induding munty: below. Please see inst�uctions%ar more informatlon.
M1btavailable in a(1 counties.)
Address /NVmber md S'vrrc) �/f�
Ciry.StareZlPCoCe Counry "�_I�_��'�������_��'
Primarypropnry ownrr conma nume E-mail
Under penalries of perjury, I hereby certi(y that this Sales Disdosure, to [he best o(my knowledge and belief, is true, correct
and complete as reyuired by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Proper[y Sales Disclosure AcC. (Note:
Spouse information, Sotial Seturity and D�iver's License/O[her numbers are no[ necessary if no Homes[ead Deductlon is
bein filed.�
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Las[Sdigirso(BuyerlDriver's Sloce LasliDigiGtajSorialSetunryNumber LastSdigivo%Bu�rer2/SpauseDriveri 5[o.e I,anSDigi[so�5xia15ecvnry
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