Homestead_Wilzbacher (2)INDIANA SABES/DISCLOSURE FORM SDF ID: Page 2
D?'PREVARE�t7-
Wi I C toss
Preparer oftheSules Disclosure Farm Title
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afol Wask"ll _�" W * I
s (Number and Street)) Company
9 PatqSvIlle 4+2-71it (
10
City, State and ZIP Code Telephone Number E-mail
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'GRANTORS z"',v`_
Ei SELLERQ ).-
T 1
Name as an conveyance document
Seller 2 - Name as appears on conveyance document
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Address (Number and Suret)
Address (Number and Street)
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Ciiy Stare, and Z(IP C
City, State, and ZIP Code
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".
Signature ofSeller
S;I/ laole.
ilk
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Prin o Seller Stan Date fMM1DD1nM Printed Monte nrSeller Sign Date (MMIDD=
1--.—BUYER(S)ZGRANTEEfS)'- 'APPLICAT FOR'PROPERTY'TAX'DEDUCTIONS-11DENTiFYs7ALE-ITEMS-THAT7APPLY=9.
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Buyer earsonconveyance document
Buyer 2- Name as appears an conveyance document
Address (Number and Street)
Address (Number and Street)
'
City. State and ZIP Code
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 19 NO CONDITION
1. Will this property be the buyer's primary
3. Homestead
residence? Provide complete address of pi-inia,,-Y----t3--�=:�2eating/Cooling
System
residence, including county:
S. Wind Power Device
503 VJ. i;61-e Qc.j Lh4hVJA, I:T
6. Hydroelectric Power Device
Address (Number and Street) I
Ha;, ta -,Au at IN i4-,l,39
7. Geothermal Energy Heating/Cooling Device
8. is this property a residential rental property?
City, State ZIP Code County
F1 F4 2. Does the buyer have a homestead in Indiana to be
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.
Not available in all coun ie
t, �s)
Address (Number and Street)
City, State ZIP Code County
I Primary property owner contact name E-mall
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-S.S, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
bein filled.) I I
29.—A /14 ,. i
/d
of guyerl 0 Signature of Buyer2lSpouse
—Wire
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Last 5 digits of Buyer] Driver's State Last 5 Digits of Social Security Number Lost 5 digits of Buyer 2 /Spouse Driver's State Lost 5 Digits ofSocial Security
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