Homestead_Hedge (2)FORM SDFID:
J. Robert Kinkle
Preparer of lhe Salu Discfature Fortn
219 N. Hart St. PO Box 13
Address(Num6erandSVret) .
Princeton.IN 47670
Ciry, Smre, and ZfPCOde
Rirth D DPaI Oatac,�y.lames Ivan 8nren. Attomey-in-Far.t
Seller 1- Name as appears on conveyvnce documen[
304 KPlly Way
Addrecs (Numberand SvtttJ
Disclosure, [o the best of my knowledge and belief, is true, correct
�mplQ ete as requir� `and is prepared in accordance with IC 6-11-5.5, "Real Property Sales Disclosure Act".
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�-�'D.r�.,.�
5/gnaaire ofSeller Signamre o/Selier
Rnth O DPaI OatPS by James Ivan Boren POA
e.r.....+u..m.�lc.11.. an�nnraruvmnmm� RinroANnmenfCallar SlanOa[efMM/�D/YYYYI
Adrian Hedae
Buyer I�- Nome at appean on ronveyance dacumen[
208 N. Scott Street
Address (Number ond Svre[)
Owensville.IN 47665
Ciry, Smre, and ZIP Code
ACL
Buyer 2- Name as appeors on ronveyance documen[
Address (Number and Street)
City.Sm[e, and ZIP Lode
THE SALFS DISCLOSURE FORM M1L1V BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE TNTT APPLY.
0 ❑ 1. Will this propercy be [he buyer's primary
residence? Provide complete address of primary
residence, including county:
5Qfl0 W 600 S '
Address (Numberand Stree[J
Owensville IN 47665 Gibson
Clry, Smm ZIP Lode [ounry
❑ � 2. Does the buyec have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated,
including county:
Addres (Number ond StreetJ
ZIPCade Counry
� ❑ 3. Homes[ead
� Q 4. Solar Energy Heating/Cooling System
❑ � S. Wind Power Device
❑ 0 6. Hydroelectric Power Device
� 0 7. Geothermal Energy Hea[ing/Cooling Device
� 0 8. ls this property a residential rental property?
❑ � 9. Would you like to receive ta�c statements for this
property via e-mail? (Provide contoct informotion
6elow. Please see instructions for more in%rmation.
Not available in all counties.)
al�- �S-o�7-zoo_a�o.34�-oa�
Adrian Hedae
A:m�.o �..��em. owner mnract name E-mall
Under peoalties of perjury, I hereby cerafy [hat this Sales Disdosure, 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 Drivers License/Other numbers are not necessary if no Homestead Deducdon is
bein filed.) �
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Slgnaa� �QOfg�ye�i � � SlgnaN�eo(BUyer2/Spouse
. . . . . . /Il I l f 1 % 9(U 2
PnnredlegalNameo/Buyu] 4 SlgnDai�(M.N%DD/YYYY)
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SatialSecurityNum6er
Litense/(D/Other Num6er
PrinredLegalNameo/Buyer2/Spouse � SlgnDare(MM/UD/vYYI)
LasCS digiGS of Buyer 2/Spouse Driver's State Last 5 DigiGS o%Sacial Security
Num6er Litense/lD/Other Number