Homestead_Jochim INDIANA SALES DISCLOSURE FORM SDF ID: PaQee 2
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STEPHANIE MILLER CLOSER
Preparer of the Sales Disclosure Form Title
1 W HWY 66 FIRST ADVANTAGE TITLE
dress(Number and Street) Company
NEWBURGH, IN 47630 812-490-8485
City,State,and ZIP Code Telephone Number E-mail
-E:SELLER(Sj/G RANT OR S)-s_.r4. : :.7-i: 1-. _ '3e; r,4 u. ' .T4,3`sy *3 3 .',ts-31- '-,�. ss .s.r L=-`_2°i_s:�is r ?zi9
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Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
.01 1\J - GlbSOii Si,
Address(Number and Street) Address(Number and Street)
1-�GW a-3hi �l4- 1 KI `i.r f 3�?
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 complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature
Signature of Seller Signature of Seller
&3( III ate+ 11 Bates 4- 5- Ic5
Printed Name of Seller Sian Date(MM/Da/YYY1) Printed Name of Seller Sian Date(MM/DD/YYYY)
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THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION II YEAS f0 rns'mTtna
❑ 1.Will this property be the buyer's primary (te Ij(J ❑ 3.Homestead
residence? Provide complete address of primary ���LLL ❑ (ix 4.Solar Energy Heating/Cooling System
residence,includi g county: ❑ 4� S.Wind Power Device
301 L) - Gl b•50 r, 5�
ddryTS(NLvmberra dStreet,l 'I q ❑ 6. Hydroelectric Power Device
`f" DJI&64 IN• �'(110 3 1 G I ❑ jal 7.Geothermal Energy Heating/Cooling Device
City,State ZIP County
❑ 6( 2. Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rental property?
IP Code
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.
so oval a. a In a COD .
Address(Number and Street)
626-/9-41 • 3471- oot. fl-0O7
City,State ZIP Code + ny
-•- •. . . , .matt name - -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.) Aft4`x-5 (3 � �Jtieki►i1 4'6'13
. IA
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