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INDIANA SALES DISCLOSURE FORM
SDF ID 26-2009-1000266
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D. PREP.kRER
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SAMANTHA CUTSINGER BROADWAY TITLE, INC.
P,epare,qllhe &;!U Dadcov, For.
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226 W. BROADWAY
BROADWAY TITLE, INC.
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PRINCETON, IN 47670
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Cin•, Smre. Doti LP Cade
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SFLLER(S)1GRA1N TORS) ,.,4
NANCY M KERR
Seller -N.,e ..pp..B com,.edment
Seller -Nmr.e of appears on comrwnce dw ioem
42 VALLEY VIEW DR.
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A&Ire. and Srrey
STAR LAKE, NY 13690
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C'm st'.... and ZIP code
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Under penalties of perjury, I herebvcertifv that this Sales Disclosure,
to the best of my knowledge and belief, is true, correct and
comp ete as required be law, an d i s prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
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Sig7wr4/Seller If
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P and S.B,q( Seller Six,, Date (ALAVDDI1T17
Aq,,� ONEFOR-DEDUCTIONSAND:CREDITS2�ID IS4FIAT APPLY
IFNFIF�V.,'ALL ITEN
rPAT'IRICIA PERSINGER
B,,er - Name as appears o,. cwrvnmse d.ntej
O, BOX 10
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WINSLOW. IN 47598
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Car. Stare, a,,d LP Coae
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Teleph.;V,aebe,
Telephone M".be, E-mail
OIE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERT DEDUCTIONS FOR TIA!ROPERTY. IDENTIFY ALL OF THOSE THAT
F 1. Will this property be the buyers primary residence? Provide com
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F. 3. Homestead
address of primary residence, including county:
oar Energy Heating /Cooling System
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226 S MULBERRY STREET
5. Wind Power Device
OAKLAND CITY, IN 47660 Gibson
r 6. Hydroelectric Power Device
cir,, S'w" I zip CW, C.ano•
7. Geothermal Energy Heating/Cooling Device •
2. Does the buyer have a homestead to be vacated for this residence? If
S. Is this property a residential rental property?
yes, provide complete address of residence vacating, including counry:
r7..9. Would you like to recieve tax statements for this property via
e-mail? (Provide contact information trlow. Please see the
instruclionsfor more in formation.Alol available in all counties./
Add . FN_=ber
d6 - &a X/_ aoa
Ca• St.,,. d7JP Code Comm,
Unaer penalties oTperjury. I hereby certify that this bales Disclosure, to the best of my knowledge and belief., is true, 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 nV necessary if no Homestead Deduction is being filed.)
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CGNIFIDEWTPAL 01%,FIDEWIW. CONFIDENTIA1
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