HomeMy WebLinkAboutHomestead_Kolb (5)A111111IN I craw pA Ire nicri riciir:Ir unrim cnr In. Paee 2
rRERARER:5
Ray M. Druley Attorney No. 4759-26
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re ra of the Sala Disclosure Form nits
N. Church Street. PO Box 146 Law Office of R v Druley
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id s(NumberandStreet) company
Fort Branch. IN 47648
City, state and ZIP Code Telephone Number E-mail
Jj!
Qhriqtopher L Mullen
Cnrrip. M Mullen
seller I - Name as appears on conveyance document
Seller 2 - Name as appears on conveyance document
293r, r John G Enad
Address (Number and Street)
Ha7lpton IN 47725
cd7JPCdde
Teleo hone Number E-mail I
Terephone Nun&er 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, apd's prepared in actor i 1 -1.1-5.5, "Real Pro e . Sales Dis gore Act".
SignaturecifSeVe, Signature ofSel er
ChtiStopher L. MUIIPn Z_
Printed Name orSeller Sign Dam LMM Printed Name ofsetter Stan Vote M
P4;'F-.!.BUYElf(5 )/,GRAN,TEE(S)'��!APPLIC-ATIONiF.OR-PROPERT�Y,T-AX,DEDUCTIONS-E,�IDENTIFY�A�C41-TEMStT�HAT'APP
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Jennifer L. McConnell
Sgachary
uyerl-Nomeasappeownc
Buyer 2. Name as appears an conveyance document
rdent
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1401 Mary Lee DE,
Address (Number and Street)
Address (Number and Street)
Princeton. IN 47670
Princeton, IN 47670
�� State and Zfl`Cade
City, State and ZIP Code
812-677-0081
Telep hone Number E-mail
I 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 CONDRIO.N
YES NO COND[TIO-
1. Will this property be the buyer's primary
R] ❑ 3. Homestead
residence? Provide complete address of primary
[:] [Z] 4. Solar Energy Heating/Cooling System
residence, including county:
❑ 0 5. wind Power Device
?915 1: John Enrd Road
E] [D 6. Hydroelectric Power Device
Address (Number and Street)
Hazleton, IN 47725 Gibson
❑ R) 7. Geothermal Energy Heating/Cooling Device
[:] [Z] 8. Is this property a residential rental property?
City, State ZIPC6de County
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
property via e-mail? (Provide contact information
complete address of residence being vacated,
below. Please see instructions for more information.
including county:
Not available in all counties.)
C7 /P `57 il
A s(Nu.ber.ndS&vsu)
City, weZIPCode County
primarvpronartyo,vnercontact name E-mail
Under of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
penalties
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". (Note:
is
pouse information, Social Security and Driver's License/other numbers are . not necessary if no Homestead Deduction
�o
, __ I _
beingfiled
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n5plire of BUYVII
2-0 12-- T!LnP.11
Number Last 5 digits of Buyer 2/Spouse Driver's State Lasts Digits ol Soctal Security
Number License)WIClaher Number
LicenselID10ther Number