Homestead_Andriakos •
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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
l D.PREPARER` �: ,:i. c.5,. , '-::-T _ ` '. -t
p�coftlmSales Disclosure Forth )� Tide
is A. ebe7'a_/SoY
Address(Number and cruet) Company
?ate r—e—J S.z, . .
Clty State,and ZIPCode Telephone Number E-mail
'U. C t AL X176 70 VA 3 8S.2'tC
`E SELLERS)/GRANTOR(S) -:W. 7;, f a x, :,'. - aS :. " , . 4 s: = - ?
,ii mes Atli X1/1/a.kos
Seller 1-Name at appears on conveyance document Seller 2-Name as appears on conveyance document
We to Cher. a St.
Address(Nu and Street) Address(Number and Street)
A42 a ar.Oti ..[i.. Se 4t0Y7
City,Stolz and 9P Code City,Statm and 913 Code
Telephone Number E-mail Telephone Number 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 re uir by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act°.
• 1 IJ/1sL
name opener Signature of Seiler
Qaetfl AN apidiked- !a- 2 a -.20/Z
Printed Name of Seller Sign Date(MM/DD/YYM Printed Name of Seger 5lgn Date(MM/DD/YYYY)
:S.BUYER(SJ/GRANTEE(S)1 APPLICATION.FOR PROPERTY:TAXDEDUCTIONS=:IDENTIFYALL'ITEMSTHATAPPLYs ' s :ctfP.v-
Boyer 1-Name asappmrs amveyanee document Buyer ata appears. con
A. ppeo conveyance document
•' r(tu brr ) Address(Number and Street)
_70 C9 r .s S +CsM4
THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDmON iD—[OMpRTO;'F�
IW❑ L Will this property be the buyer's primary / (p— ❑ 3.Homestead
residence? Provide complete address of pri ary — nergy Heating/Cooling System
residence,q{dydigg county:
_2G 6 W ❑ (� S.Wind Power Device
�Afi,dr (Number and �eY`�^ / ❑ [,x 6.Hydroelectric Power Device
r 'p"`eft'" 41 7 670 6 ' 4 5 6;- ❑ [' 7.Geothermal Energy Heating/Cooling Device
Ciry,State 9P Code Camp
❑ Er.' 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ C3' 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.
'o available in all counties.)
Address(Number and Street) �
City,Slate 2713 Code �. a 4 -la °7 -/09-000. _O 2-8
Primary property owner contact names
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