Homestead_Baize •
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„pie Lawyer
e Sales Disclosure Forth Title '
�- !Hart Street
Hall, Partenheimer&Kinkle
dress(Number and Sweet) Company
Princeton, IN 47670 812-386-0050
voi City,State,and ZIP Code Telephone Number E-mail
ESSEL•LER(S)%GRANTOR(S)._.. •t:-.-r- .-_-� .__ .�1 _ ,:�:Tra ...>,.-x..._.X a.Ca-a.:..._ . 1.0.5'I� .,T:.,
Theresa Wagner as Pers Rep Fstate of John R Clark
Seller I-Name as appears an conveyance document Seller 2-Name as appears an conveyance document
4330 West CR 200 South
Address(Number and Street) Address(Number and Street)
• 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 c lete as re e aw,and is prepared in accordance with IC 6-1.1-53,"Real Property Sales Disclosure Act".
c.
nature ofSel,er Signature of Seller
heresy Wagner Pers Reo 12-/a/20/O
Printed Name of Seller Sigh Date(MM/DD/YYn) Printed Name of lIer Sign Date(MN/oD/m'Y)
.F4BUYER S ,GRANTEES"APP,LIGATION iFORIPROPERT€YTr1X:DEI)l( •- .1 °dDENTJEYALI ITE -, ATAPPLY. : `f
Patrici. Binhack Christine Baize
Buyer T-Name as appears on conveyance document Buyer 2-Name as appears on conveyance docume
107 S.Spring Street,Apt.3G 106 Southwe,t Street
Address(Number and Street) •• — •' ' weer)
/Th'
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION NO CONDITION
❑ ri 1.Will this property be the buyer's primary M Isi 3.Homestead
residence? Provide complete address of primary • 0 4.Solar Energy Heating/Cooling System
residence,including county: ❑ 0 5.Wind Power Device
Address(Number and Street) ❑ Q 6.Hydroelectric Power Device
❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
SI
❑ 12 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 ❑ p 9.Would you like to receive tax statements for this
complete address of residence being vacated, • ••---• . ' :' . • • ide contact information
including county: bielownlevelA iieritrAcifieri t r .. 14 i •• ii.T.
pl6�1AOTCPS7/bi i'courke1/
Address(Number and Street) a 7
...�._ .-a- -4..... �_ ��,.
City,State ZIP Code County .
Primary property owner contact name E-mail