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INDIANA SALES DISCLOSURE FORM 5DF ID: Page 2
D.PREPARER
Preps o e Sales Disclosure Form Title
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Address(Number and Street) 1 Com n
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OW State,o s- n It- k `a23 Telephone Number
'ZI E-mail
E.SELLER GRANTOR(S) - , " ' -
Seller Name as appears on conveyance document i Seller Name as appears on conveyance document
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Number andStr&l Address(Number and Street)
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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
an complete as re uired by law,and inprepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
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pS�ignature of 1 Signature ofSeller
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Printed?Aline of Seller Spa Date(R.a(DD/YYf) Printed Name of Seller Sian Date(MM/DD/ITYrt
F.BUYER GRATRl c -APPLICATION FOR PROPERTY TAXDEDUCTIONS4 IDENTIFY ALL ITEMS THAT APPLY- ,;.7?[ r`;: r _i
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to.. I-Name as appears on ranveyan- •ocament Buyer 2-Name as appears on conveyance document
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Address and Street) ^ Address(Number and Street)
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CDNDmON YES NO rnMnrfgy
li ❑ L Will this property be the buyer's primary 3.Homestead
residence? Provide complete address of primary ❑ ay 4,Solar Energy Heating/Cooling System
\� residence,i ludingcounty:
M t ❑ [Y 5.Wind Power Device
,-.4ddrem(Numberand t t) ❑ [� 6.Hydroelectric Power Device
tic sea Wed. \u• ` v^ q_� coon y ❑ of 7.Geothermal Energy Heating/Cooling Device
❑ (f 2.Does the buyer have a homestead in Indiana to be ❑ [J 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ V9.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.
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Address(Numbs and street)
a2Ga - ii � - ca0V- oaoe / 7 v-vae
CIty,Smu7JPCde Cou - -
Primary property owner contact name ,all
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(( ``\fii�lrred.)`` '' )r\0-1
Signature o Buyer1 Signature of
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