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INDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
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Rav M. Drulev Attorney No. 4759 -26
parer ofthe Sala Disclosure Form Tide
05 N. Church Street, P.O. Box 146 Law Office of Ray Drulev
Address (Numberand Street) Company
Fort Branch IN 47648
Sherries R Ziegler
Carolyn K Zenthnefer
Seller I - Name as appears on conveyance document
1012 W. Cihson
Seller 2 - Name as appears on conveyance document
202 S 5th Ave
Address (Numberand Street'
Hauhstadt IN 4763q
Address (Number and Street)
Hanhstadt IN 4763q
0 ,Smte and TJPCode
City. SwM and ZIPCade
�
E -mail
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
nd cplete a(s re uired by law, and is prepared in accordance IC 6- 1.1 -5.5, Real Prope Sale Disclosure Act ".
SignamreofShcer �,C Sgnature ofSel er /
30 -V q
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Sherrie R Ziegler 1 Carolyn K. Zenthoefer 4ol J Q -Q f
Printed Nameo Seller Si nDam(NM D Printed Name o Seller Sian Dow (Mu D
IF ER 8-.2IRMA14 E S V A PP,LIGATIONJF,ORrRROPERT-
yrTAX+ DEDUCTIONS-'
IDENTIFYIfdI ]L ;ITEMS:THATIAPP,EY
w M n
uyvl -Nameo rs an conveyance document
Buyer 2- Name as appears on conveyance document
153 dtt Drive
Address (A'umber and Street)
Address (Numberand Street)
ansville IN 47725
' E -mail
Tele hone Number E -mail
THE SALES DISCLOSURE FORM MAYBE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION NO CONDITION
❑./ ❑ 1. Will this property be the buyer's primary QQ
Q ❑ 3. Homestead
residence? Provide complete address of primary
ergy Heating /Cooling System
residence, including county:
E] [Z] S. Wind Power Device
506 E Haub St
_ .
❑ Q 6. Hydroelectric Power Device
Address (Number and Street)
Haubstadt, IN 47639 Gj bSo ll
❑ Q 7. Geothermal Energy Heating /Cooling Device
❑ ❑`� 8. Is this property a residential rental property?
city, sue PCode County
❑ 2. Does the buyer have homestead in Indiana to be
a
vacated for this residence? If yes, provide
❑ [Z] 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.)
�� �? `J J/ O�
Address (Numbs and Street)
Ci ty, S m te VP 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
be in filed.)
ofBuyerI Signature ofBuyer2/Spouse
Temi a -3v -(D
Printed
Last 5 digits of Buyer l Driver's State Last 5 Digits oirSocial Security Number Last 5 digits of Buyer 21Spouse Driver's State Last 5 Digits of5ocial Security
License/1D /Other Number Number License/1D10ther Number