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Homestead_Church (2)
INDIANA SALES DISCLOSURE FORM SDF ID SDO ID 1397167 Page 2 D.PRE PARER . Semantic.Cutsineer Preparer of the Sales Disclosure Form Title 226 W.Broadway Broadway Title,Inc. Address(Number and Street) Company Princeton,IN 47670- E.SELLER(S)/GRANTOR(S) ' . - Robert J Brickley Jr Lisa K Brickley Seller I-Name as appears an conveyance document Seller 2-Mune us appears on runvevunte document 902E 1200 S 902E 1200 S Address(Number and Street) Address(Number and Street) Haubstadt,IN 47639- Haubstadt,IN 47639- ) ''N'S. E-mail ell Met-p nalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and cotlete as required by law,and is prepared in accordance with I 6-1,1-5.5,'Re 1 Property Sales Disclosure Act". • ( ,I -1- ' 1''1A.0 feiA gn tare ofSeller 9'g store of Seller -`'?cz 3Z c.cL \ - I - as- 5 Li so\ K, Rrfc-kl et _ 1-0S /3 Pr41e,e Nam.nibn.- i%vn nn Fs r Ism r M'VN Pr,n, N^•"""!UI r Cp..,Mm fwnTr/lvmi to h.TEES)-APPLICATION FOR PROPERTY TAX DED13C'ITO NS-IDEN LL ITEMS TH T APPLY Jeffrey T Church C dress M Church r_•_t.--.. appears on conveyance document uyer ame as appears on convevnnce document 501 N WIlard St. 501 N.Willard Address(Number and Street) Address(Number and Street) Ft.Branch,IN 47670- Ft.Branch,IN 47648- Iv 1A __ j I A_ Telephone Number E-mail Telephone Number E-mail THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS 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: ❑ 902 E 1200 S 5.Wind Power Device Address(Number and Street) ❑ ❑ 6. Hydroelectric Power Device Haubstadt,IN 47639 GIBSON ❑ © 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County © ❑ 2.Does the buyer have a homestead in Indiana to be ❑ © 8.Is this property a residential rental property? 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. 501 N WILLARD ST. Not available in all counties.) Address(Number and Street) 'ny g�M1/� //yy'�� ,^I Ft.Branch,IN 47648 GIBSON �3 -61—(•/60_C6„//e/3-7 (/� City.State ZIP Code County !!// Primary property owner contact name E-mail Under penalties of perjury,I 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 5g a••re of Buyer? A nature ofBuyer4/Spouse 1itiTCtiv/cL o/-1sd0/3 A1\dc�en t4\ �--\\0(Lb\ ∎-a "- aol1)