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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER
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Preparer ofthe Sales Disclosure Form Title
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Address (Number aniBVeeti W. FOURTH ST, STE 500 Company
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47708 Ciry, Sm[e and ZlPlade Telephone Number E-mail
E. SELLERS GRANTORS
Seg me c onvy ment
Sd/er2- Na�as appears on conveyance docirmint
l �urs,
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Address (Number and Sweet
Address (Number and Street)
E -mail
I Telephone Number E -mail
UndeEpealties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and cs required law, and i prepared in accordance wit rFC�- 1.1 -5.5, "Real Property Sales Disclosure Act ".
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Sign eofSeller 1 Signature of SeJler
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nted Nameo Seger S'an Date Hw/Da Printed Nameo Shcu son .!f4
F. BUYERS GRANTEE S =APP CATION FOR PROPERTY TAX DEDUCTIONS- IDENTIFY ALL ITEMS THAT APPLY
BVerl - Name as appears on conveyance merit
Buyer 2- Name as appears on conveyance document
51
Address �kA (Numberand Street)
ut�Si �1r�
Address (Number and Street)
E -mail
Tele hone Number E -mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FO ROPERTY. IDENn OFTHOSE THAT APPLY.
YES NO CONDITION I YES NO CONDITION
❑ 1. Will this property be the buyer's primary
FZf ❑ 3. Homest d
residence? Provide complete address of primary
o ar Energy Heating /Cooling System
resideq/ce�ii'nncqluding county:
❑ 5. Wind Power Device
�I'�S•�nVln <Z- LJYYIC_.
❑ 6. Hydroelectric Power Device
dress (Number an so- , I , I n ,
C:I
( �'�5� IV 'h, 03.1 YJL�
❑ 7, Geothermal Energy Heating /Cooling Device
C] S. Is this property a residential rental property?
City, State PCode County
El 2. Does the buyer have a homestead in Indiana to be
,
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
including county:
below. Please see instructions for more information.
Notavailable in 1 counties.)
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Addrem(NumberandStreet)
City, State ZlP Code County
Primary pry a owner conwaname 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
bei filed.)
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+..� Signature ofBvyer2/Spouse
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Printed LegalNorneofBuyer l I�
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Last5digitsofBuyerlDriver's State Last 5 Digits ofSacial Security Number Last 5 digits of Buyer 2 15potue Driver's State Lasts Digits ofSonal Security
License /iD /Other Number Number License/ID /other Number
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