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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER -_ -
•
Stacey Salzman Closing Officer
Preparer of the Soles Disclosure Form Title
8711 W HWY 66 First Advantage Title
Address(Number and Street) Company
•
Newbirqh, IN 47630 812-490-8485 theteam0firstadvantagetille.com
City,Stole and ZIP Code Telephone Number E-mail
E.SELLER(SVGRANTOR(S) . . .
Jim C7ner d/b/a C,ner Construction
(Semler l-Name asp7Y/'rsy[o/ nnv ncedocumnl Seller 2-Name asa appears on conveyance document
W ( ''eo�/{C�f ej'q„ — i` 3 . PPm el'a
e s umber np d—r_er1) P►'-'}`,v�^l n-1 t Y 5 Address(Number and Street)
City,St and ZIP Code,..\,_IJ,... (�(`/Y� City,State,and ZIP Code
City, ciob- L54S7
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 complet s requ/led by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
--./ ^
Printed Name of Seller Sian Date(MM/DD/YYYn
F.BUYERfSyGRANTEE(SJ APPLICATION FOR PROPERTY TAX DEDUCTIONSs"IDENTIFY ALL ITEMS THAT APPLY _
Scott Andrew Wal.en
,. aisp.4 • ent Buyer 2-Name as appears on conveyance document
G i 6i .•II mill_ a 7
re.( umber and Street) Address(Number and Street)
T i ILO ors,.[ 7(P(P5
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 NO CONDITION /I .Y
g ❑ 1.Will this property be the buyer's primary ( 0 ❑ 3.Homestea
r idence? Provide complete address of primary -❑ 4.Solar Energy Heating/Cooling System
• n / ,SiSle/Ire,incly.iag cou - ❑ 5.Wind Power Device
4 r sstNUmbe dStreet ❑ L 6.Hydroelectric Power Device
"^ ' (0& I bou County y ❑ 7.Geothermal Energy Heating/Cooling Device
Ciry,State ZIPCode
❑ �-`-IF1L,t` 2.Does the buyer have a homestead in Indiana to be
I ❑ 8.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.
Address(Number and Street)
City.State ZlPlade County '76 -/7 -o/ - 4/0Y-000. /O y -oa )-
•••■ Pd rnamr -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
bein: fil //
r,
X.�o\—,1- l e id(,' / t, )(2-1-41,4b3 Signature o Byer2/Spouse
TtTt��''1ILL til try/(�
Number License/ID/Other Number