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INDIANA SALES DISCLOSURE FORM SDF ID: Pace 2
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parer of Me Sales Disclosure Form Title
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City State,a ZIP Code Telephone Number E-mail
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Seller I-Name cs appears on conveyance document Seller 2-Name as appears n cony nce document
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Address(Number and Street) Aid/as(Number and Street)
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Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complllete s required by law,and is prepared in accordance with 10621.1-5. "Real Property Sales Disclosure Act".
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Si nature tS ler' ignamre of Seller
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Printed Name of Seller Sian Date MM/DD l,IU�LGI3
( /Iri1) Printed Name of Sian Date(MM/DD/YYY"Y)
.F.BUYER(VGRANTEE(V APPLIGATIOKFORTROPERTYsTAX,DEDUCTIONS IDENTIEVALIIITEMS,THATrAPPLY' r -',-.r"
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Buyer I-Name as appears an conveyance document Buyer 2-Name as appears on conveyance document
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Address(Number and Street) Address(Number and Street)
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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 I YES NO CONDITION
❑ 1.Will this property be the buyer's primary s" ❑ 3. Homestead
residence? Provide complete address of primary ❑ p- 4.Solar Energy Heating/Cooling System
residence,including coun
S--ayer\-e 'as Ti"b03 ❑ S.Wind Power Device
Address(Number and Street)
��I� ❑❑ p_ 6.Hydroelectric Power Device
C 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ e- 2. Does the buyer have a homestead in Indiana to be ❑ 8.1s this property a residential rental property?
vacated for this residence? If yes,provide ❑ Gr 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.
TN. -Z Not available in all counties.)
Address(Number and Street) ' /j /^�� ,,II /
• Ciry,Sm[e ZIP Code County a�../9 0 _V-- -`a"ja
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 .ecurity and D 'ver's License/Other numbers are not necessary if no Homestead Deduction is
being filed.) / /
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Signature of Buyer! Signature ofBuyer2/Spouse
. Number License/ID/Other Number