Homestead_PowellINDIANA SALES DISCLOSURE FORM SDF ID: Paee 2
D. PREFARER .: €_
Theresa Smith Title Clearer
Preparerof the Sales Disclosure form Tide
4877 Galaxy Parkway Suite I Mortgage Information Services
dress (Number and Street) Company
✓eland Ohio 44128
E -mail
E- SEft S1 NTOR S
Bradley Powell
Heather Powell
Seller I - Name as appears on conveyance document
411E Cherry Street
Seller 2 - Nome as appears on conveyance document
411 E Cherry Street
Address (Number and Street)
Oakland City IN 47660
Address (Number and Street)
Oakland City IN 47660
Ciy, State, and ZIP Code
City, State, and ZIP Code
E -mail
Telephone Number E -mail
Under penalties of perjury, 1 hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as re uired by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ".
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Signature ofSell S(gnatare af5eller
Po(�e11 q-C�(� - ,Aoto
need Nameo( Iler Sion Date (MM ✓DD l Printed Name of5eller Sian Date(MM ✓DD
: SUYE
5 GRANTEES . `APPLICAI N FOkPROPERTY PROPERTY.—
IDENT]FY AL.L ITEMS THAT APPLY .
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Powell
Buy -Nome osappears on ace document
Buye r2 - Name as appears on conveyance document
411E erry Street
Address (Number and Street)
Address (Number and Street)
Oakland City IN 47660
and ZIP Cade
City, State, and ZIP Code
.State,
E-mail
a hone Number E -mail
THE SALES DISCLOSURE FORM MAYBE USED TO APPLY FOR CERTAIN DEDUCTIONS THISPROPERTY. IDENTIFY ALL OF THOSE THAT APP '
YES NO CONDITION I YES NO CONDITION
❑✓ ❑ 1. Will this property be the buyer's primary
Q [� 3. Homestead
residence? Provide complete address of prima
Ing /Cooling System
residence, including county:
ll
✓ 5. Wind Power Device
4 f= CHcrz2V s[•
❑ ✓ is Power Device
Address (Number and Street)
OA K LA^(p C fTy Itz"0 ,
❑ Q 7, Geothermal Energy Heating /Cooling Device
❑ ✓❑ 6. Is this property a residential rental property?
City, State ZIP Code County
❑ ❑✓ 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
❑ ✓❑ 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:
below. Please see instructions for more information.
Not available in all counties.)
- /" �41- 00/. /3 -00 7
Address (A'umber and Street)
City, State ZIP lode County
Pn'mary property owner contact name E-mail
Under penalties of perjury, l hereby certify that this Sales 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 not necessary if no Homestead Deduction is
being filed.)
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sta re of Bl Sign a tare of
Printed Legal Na(eof Buyer I Son Date (MM✓DD✓YYY11 Printed Legal Name of Buyer 2 1Spouse Sign Dore (MM✓DD✓YYY3)
Number Last 5 digits of Buyer 2 1Spouse Driver's State Last 5 Digits of Social Security
License /ID /Other Number Number License /ID /Other Number
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