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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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• Preparer o/�he5a1 D' I�; yr assure Fprm 6 (0/ Titler� )sSt7 c
Address(Number and ttj ttJ)WI(./",••t Cam'((paJ(n('
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Ciry,State,and ZIP Code Telephone Number E-mail
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E SELLER S)/GRANTO[2(S ^etr...q i r.. ,�; ,, z—:. ,s�� . .. sr y ,.. .s- ,:;.`v-.,i - ..
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II --Name as pears on comveyan[ ument Seller Name as on conveyance do nt
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Add (Number and Stre<),i/ ,I-766S- Address(Number and SOW)
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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 c ow to a assp/�"uired by law,and is prepared in accordance with IC 6-1..11--5.'5,,""Real Property Sales Disclosure Act".
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Printed Name&Seller Sian Date(NN/DD/YYYY) Printed Name of Selle Sion Da. Dust/DD/YYYY)
-FFBUYER(S %GRANTEE(S)' AP:PI ICAT(ON,E0WPROP,ERTY1 LTAX iDEDUCTIONSJIDENTIEWALUITBMS THAT+AP,PLY.'' n - :`=
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B erl-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
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Address(Number and*et) Address(Number and Sweet)
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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 0 CONDITION - YES NO CONDITION
. pf❑ 1.Will this property be the buyer's primary ["❑ 3.Homestead
residence? Provide complete address of primary ❑ 2—4.Solar Energy Heating/Cooling System
518 I, Fesitjq ruink in�coµnt � ❑ t�t� 5.Wind Power Device
0 (NumbeWsnd ul3tt)� y—��,1(i-/_S 64.(__ ❑ Uv 6.Hydroelectric Power Device cps
lit'-e �) SPY! LIS ❑ 12f 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County ❑
-❑ [''2.Does the buyer have a homestead in Indiana to be Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 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.
Not available in all counties.)
Address(Number and Street)
(QG- 1/1-1a- 'Da-ono. -oat
City,State ZIP 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 6-1.1.53,"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 Bed.) -
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Signature o eu er2 5 Ouse
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Number License/ID/Other Number \3/41^\`
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