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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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•Preparer of the Sala piurlosure Form Tide rij y0'i —1 5--0
Address(Number and Street) Company
P'r'I IICe eY"' , 't A) 91(c '2a it 2- 66Y- 60,-2
City,State,and EP Code Telephone Number E-mail
E.SELLERS)/GRANTOR(S) “:',J,;;'''..±;:::-.
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Seller I-Name as appear on conveyance document Seller 2-Name as appears on conveyance document
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Address(Number and Street) A((5ess(Number and Street) �1 y�
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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 ry law,and is prepared in accordance withhh IICC 6-1.1-5.5,"Real Property Sales Disclosure Act".cae
Sign er required
Signature of Seller
I"1D`vT3/4 w )-)nyrl O? l?-2613 ..)arnes L)vyc/ C9-14-201;3
Printed Name of Seller Stan Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF TH
YES NO CONDFON I YES NO CONDmON
if ❑ I.Will this property be the buyer's primary IN ❑ 3.Homestead SEP 19 2013
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
residence,including county:
103 S.a) Y1 I ❑ 0 S.Wind Power De •a
r l i1e!1141
Address(Number and Street ❑ 0 6.Hydroelectric Ps�''' •. •4-
P`COK Q. -1-- `/ (c (oION CU AUDITOR
City,State ZIP Code County ❑ 7.Geo[he ergy eatrng/Cooling Device
❑ iz 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 ❑ Eia 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.
Not available in all counties)
Address(Number and Street) /� - s- 101 9ra� oao
City,State ZIP Code County [�I�_O� (�/S� ��00 ' •"�
Primary property owner contact name E-mail