Homestead_Miller INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
;D:PREPARE Ft; :4; - •
J.ROBERT KINKLE ATTORNEY
Prepare'of the Sales Disclosure Form Title
219 N.HART ST HALL,PARTENHEIMER&KINKLE - -—
Address(Number and Street) Company
PRINCETON,IN 47670 812-386-0050 irkinklefahok-law.com
Oty.State,and ZIP Code Telephone Number E-mail
JEREMY B SHOULT7
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
6467 E 500 N
Address(Number and Street) Address(Number and Street)
FRANCISCO IN 47649
Telephone Number
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
an c mplete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
foetal o4r 1 Signature of Seller
JERE B SHOULTZ
Printed Name of Seller Sign Date(soilloaffsrl Printed Name opener Sign Date(Mll/DoM7Y)
F.BLIYER(5)/GRANTEE(5).E.APPLICATION FORTROPERTY TAX'DEDLICTIONS, IDENTIFY ALL•ITEtv.15 THATAPPLY
NICHOLAS W.MILLER
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
218 SOUTH ST
Address(Number and Street) Address(Number and Street)
HAZLETON,IN 47640
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 0 ONDITION
Mt 1.Will this property be the buyer's primary 9 3.Homestead
residence? Provide complete address of primary LI IA 4.Solar Energy Heating/Cooling System
residence,including county:
Li 19 5.Wind Power Device
Address(Number and Street) 9 IA 6.Hydroelectric Power Device
9 IA 7.Geothermal Energy Heating/Cooling Device
State VP Code County
9 IA 8.Is this property a residential rental property?
2.Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes,provide 9 0 9.Would you like to receive tax statements for this.__ •
- ---- --property via"e:mail?(Provide contact information -
complete address of residence being vacated,
including county: below.Please see instructions for more information.
rilA fu Not available in all counties)
Add (Number and Street)
k4A7A—F Ja 11L4° Ct 650/j a(Cr—°(CI — 1 3--a —COO ./6 7-0/7
City,State ZIP Code County
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.S,"Real Property Sales Disclosure Act".(Note:
Spouse information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
bek,
Signature of Buyer! Signature of Buyer2/Spouse
NICHOI AS W MI)I FR 6/060-03
Number License/ID/Other Number