Homestead_Kolb (2)INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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Rav M. Drulev Attorney No 4529 -26
Preparer ofthe Sala Disclosure Form Title e _
'O5 N. Church Street PO Box 146 Law Office of Ray M. Drulev
Address (Number and Street) Company
Fort Branch, IN 47648
3EFSELL1ER S `,GRANTORS
lam c N Deffendall
M'IPOn I Drffendall
Seller I - Name as appears an conveyance document
4864 N 650 F
Seller 2 - Name as appears on conveyance document
4864 N 650 F
Address (Number and Street)
Francisco IN 47644
Address (Number and5trea)
Frnnriscn IN 47644
City, State, and ZIP Cade
City, State, and ZIP Code
(
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 Lured by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ".
� \ � t... �� A✓ ter/ -x--22
�el�
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S' a re of5eller Sign tureture of�
M'lena L Dnffendall 05106/2011
Printed N Seller sign DOW (MM MD Printed Name o Setter Sign Date MM D
.— _ .. ._ _
BU,YER 8 `.GRA . -$E S SAP. P, 66ATION1F .OR?PR0P.ERTATAXIDEDUCTIONS
-- - __ _. _ .ti
�IDENTIu ,A1'01TTEMS.TA ATM P,P,L'Ys'E
Heath Kolb
Buyerl -Name pearz on conveyancedocoment
Buyer 2- Name as appears on conveyance document
4 E. Old Petersburg Rd
Ad r berand Street)
Address (Number and Street)
Princeton IN 47670
State, and ZIP Code
City, Stung. and ZIP Cade
Tele hone Number E -mail
Telephone Number E -mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THISPROPER ETRAT APPLY.
YES NO CONDITION NO
Q ❑ 1. Will this property be the buyer's primary
❑✓ ❑ 3. Homestead
residence? Provide complete address of prim
,/ 4. Solar Energy Hea ' Doling System
residence, including county:
❑ ❑✓ S. Wind Power Device
4869 E
❑ Q 6. Hydroelectric Power Device
A'umber Street
Address s(Num and
Address )
Francisco IN 47649 Gibson
❑ Q 7. Geothermal Energy Heating /Cooling Device
E] 2) 8. Is this property a residential rental property?
City, Slow Code County
❑ L 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
below. Please see instructions for more information.
including county:
Not available in all counties.)
� � —�i / Re -yon 127a, O/�
Address (Number and Street)
City, State LP Code County
Primary property owner contact name 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
being filed.)
' Sjg nawreafBuyerl Signature ofBuyer2/Spouse
Last 5 digits of Buyer l Driver's State Last 5 Digits of Social Security Number Last 5 digits of Buyer 2 1Spouse Drivers State Last 5 Digits of5ocial Security
License /ID /Other Number Number License/ID 10ther Number