Homestead_JinesINDIAN 'SALES DISCLOSURE FORM SDF ID:
PApr* 2
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M. Druley Attorney No 4759-26
—Ray
Prepares of the Soles Disclosure Form Title
05 N. Church Street. P.O. Box 146 Law Office of Ray M. Druley
Address (Number and Street)
.lack H ("agsarla
Mgrheth Cassada
Seller I - Name as appears on conveyance dominant
11r R Filppn
Seer 2 - Name as appears on conveyance document
116.1; F*lppn
Address (Number and Street)
Hauh0ndt IN 47619
Address (Number and Street)
Hauhqtadt IN 4763c)
CltySwM and ZIPCode
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 P operty Sales Disclosure Act".
PBZ�g�
nature r Signature of Seller
Ja H rqg�ad� 11122/9010 IvInribeth Cassada 1119919010
Prin tgodIftGe ofSdler Sion Dow (MMIDPIYYYY) Printed Name ol'Seller Sign Dow (MMIDDIYYYY)
�F.4UYER(S)
/,G OLNTE E(SfL-'AP N CATI 0 N! FO R P. ffo P.M.TjYjAx -6-Eb
u c-TI 0 N Sri I D E NT I FY A7LL!iTE qS offfMt A P. P
Kimberly M. Wallace
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Buyers -Name asappenaoncom, or ocument
Buyer 2 -Name as appears on conveyance document
1328 E. Taftown Road
ddress (Number
Address (Number and Street)
Hnnmeton_ IN 47670
J , tAandZIPCode
City, Siour, and Zip Code
Telep hone Number ail
fOR CERTAIN DEDUCTIONS F IS PROPERTY. IDENTIFY ALL OF THOSE THAT A LY.
YES NO CONDITION YES NO CONDITION
he buy
1. Will this property bet buyer's prima
2] ❑ 3. Homestead
)
residence? Provide complete address a
f
Cling System
❑ So r t stem
4. Solar Energy Hea ti Co
Energy
residence, including county:
I
❑ R] S. Wind Pow vice
1,128 F Taftown Rood
V ro ct C Power
EJ Eq y roelectnric Power Device
Address (Number and Strent)
Gib
Princeton, IN 47670 Gib
❑ R] 7. Geothermal Energy Heating/Cooling Device
[] [Z] B. Is this property a residential rental property?
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or, yCade cou
2. Does the buyer have a homestead in Indiana to be
E]- ❑ 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide
complete address of residence being vacated,
property via e-mail? (Provide contact information
below. Please see instructions for more information.
including county:
Not available in all counties.)
').
a4re
Address (Number and Strent)
CitySmte7JPCode 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
being file
' signaturecirg*r Signature ofituyer2l5pouse
I
--- 1112919010
We 1 1 — son Dow (mmIzut1wrn
Number Last 5 digits of Buyer 215pouse Driver's State Lost 5 Digits of Social Security
License/1D /Other Number Number LicertselID10ther Number
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