Homestead_Pyle (4) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER :__ x.rl:-I.s % .. ...r: cf = 'A_`.-. L r 1%:;51.Ye.Z,fRa4 . .? - r ..� <: n. .. .,. __c._ f
Preparer of the Sales Disclosure Form Tide
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Address(Number and Street) Company
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Ciry,State and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTORtS) a. '+s_,_y sm._ sy'g'eir., ::...:_ si ,',`.`sg .. .. -3 '.._c.:. °_;_sa,Wa_�"�a_--'�_`°.t ".,
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Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
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Address(Number and Sheet) Address er(Number and Street)
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City,State and ZIP Code City.State and ZIP Code
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Telephone Number E-mail T.Agiune 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 complete s required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
'Agnat6e'o Signature ofSeller
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Printed• - . • Seller O �7.n bate(MM/DD/YYTY) Printed Name ofSeller Sign Date(MM/DD/YYf)
T. :I R(S)%GRANTEE(S) APPLICATION:FOR :ROPERTYITAX,DEDUCTIONS4:1DENTIMALtITEMS9THAT:APPLY.....niXAT
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Buyer 2-Name as appears on conveyance document
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Address(Number and Street) Address(Number and Street)
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PROP+• " .•a• 'A. a • e -T APPLY.
YES NO [GNOMON -. NO [GNOMON
Dif 1.Will this property be the buyer's primary 1: ❑ 3.Homestead
residence? Provide complete address of prim. • E G •. oar Energy Heating/Cooling System
resides including county:
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O$ N $ E 5 T [r
❑ ' 5.Wind Power Device
.ddress(Number and Street) (� ❑ 2 6.Hydroelectric Power Device
"n- N y 11310 ❑ 2r 7.Geothermal Energy Heating/Cooling Device
City,State 2IPCade County
❑ [ ' 2.Does the buyer have a homestead in Indiana to be ❑ Q/ $ Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ LI 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(Numbs and Street) /I6 - I )- ( - ^O3-001 • )53£) 2 OV
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City,State ZIP Cade County [^J(J CX/
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.)
Signature of Buyerl Signature ofBuye-2/Spouse
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Number License/1D/Other Number