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INDIANA SALES DISCLOSURE FORM SDF ID: "`W oW - M OU�?_
Page 2
D:PREPARER ,
' Preparer ofthe Ies Disclosure Form Title
Address (Number and Street) 10 1 AL I ( f LE SER VI CES. LLC Company
19 N. W. FOURTH ST, STE 500
City Scam and ZlP Code - ANSVILLE. IN 47708 Telephone -� Email
- EBELLER S GRANTORS
I - Nanie ns.ppears an conveyance document
Seller 2 -Name as appears on m veyvncedacument
1 945 to �7-cf'5
A
Address (Number and Street)
Address (Number and Street)
N4/,as7�4 Z:& '17'
City, Smce,
certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as! quired by law, and is prepared in accordance with IC 6.1.1 -5.5, "Real Property Sales Disclosure Act ".
1 nature of Seller Signature of5e/
-o
Priming Nomeo(Seller Sian Data MM /DD PrintcM Nameo(Seller Sia. Date fMM DD
;FCBUYER S `GRANTEE S =APPti CATION:FORPROPERTY.T - DEDUCTIONS - IDENTIFY ALL ITEMS.THAT APPLY
Buyer I- Name as appears on cony ce document
Buyer 2- Name as appea on co veyance document
on - �<
Y.
Address (Number and Street)
Address (Number and Street)
E-mail
Tele hone Number E -mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTION! FOR TH IS PROPERTY. IDENTIFY ALL OF THOSE THAT AP7.
/ —KO
YES NO CONDITION YES CONDITION I
❑ 1. Will this property be the buyer's prima
❑ 3. Homestead
residence? Provide complete address f primary
esi$e cl tx:
❑ 4. Solar Ener Heating /Cooling System
- / Al �
-Wm Power Device
❑ Ey 6. Hydroelectric Power Device
❑ 5/7. Geothermal Energy Heating /Cooling Device
�/
❑ I,� -, /$' Is this property a residential rental property?
A dress rv�/bU�/St(e /� .l 7� �L /'i
7-/ / (�'
City, mte PC de County
❑ 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
❑ FD 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 formore information.
Not available in all counties.)
dl / /_ 0/- d9. 45'QS
Address(Numberand5treet)
CitySmte ZIPCode County
Pn'mary propertyownerronmct name Email
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 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
ed.)
Si nature ofl7uyerl Signature 0 fBayer2 Spouse
- / /- �. - d C C�C7CJlC�' -�
1Spouse Driver's State Last 5 Digits of Social Security
License /ID10ther Number Number License /ID /Other Number