Homestead_Krieg (4) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER n &*- - ".
Ray M. Dailey Attorney No.4759-26
Preparer of the Safes Disclosure Form Title
505 N.Church Street,PO Box 146 Law Office of Rav M. Drulev
Address(Number and Street) Company
Fort Branch,IN 47648 812-753-4975 drulev(e)insightbb.com
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S). - - -
George J Vickers
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1625 Machine Branch Rd
Address(Number and Street) Address(Number and Street)
Ewing VA 24248
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.b law,and is pre ared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller Signature of Seller
George J Vickers July 19 2013
Printed Name of Seller Sign Date(MM/DD/MT) Printed Name of Seller Sign Date(MM/UD/YYYI)
•F:BUYER(SV GRANTEE(S)`-APPLICATION FORPROPERT•Y,tTAX DEDUCTIONS=IDENTIFY-ALL ITE H- ' •
• I
•
:uyer - 'am •• ••ppears on conveyance document ,mot / Buyer 2-Name as appears on co • m• •. � t
6347 WI 0; visioli fll(l�/� X2013
Ad ess(Numberand Street) Addressbytond�¢get JUL p
Pei-9.1;5 6vf-
THIS PROPERTY. IDENTIFY ALL 0 HOSE THAT APPLY.
YES NO CONDITION Y BfTig.1_,
❑ 1.Will this property be the buyer's primary _ 151 ❑ 3.Homestead
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
- residence,including county: ❑
305 N Center 5.Wind Power Device
Address(Number and Street) ❑ igi 6.Hydroelectric Power Device
Francisco,IN 47649 Gibson
7.Geothermal Energy Heating/Cooling Device
City, tote ZIP Code County
2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ NI 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
including conty: , r below.Please see instructions for more information.
g707 tv, V f y/5 t o/n Ro( Not available in all counties.)
Address(Number a Street r-
Pefrrsbuf-51 >� Y7S67. Pikk �6 - /3 - 17 - 303 - 000. 0197 - o0.3
ty,State ZIP Code County
Primary pro perty 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 Drivers License/Other numbers are not necessary if no Homestead Deduction is
being filed.)
.
.Wia li Kn
Signature of Buyer! Signatur BuyerfSpouse
1