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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
(D P,REP,ARERr- - , r:, - "el, __ . _ - f
Ray M.Drulev Attorney No.4759-26
Preparer of the Soles Disclosure Form Title
505 N.Church Street,PO Box 146 Law Office of Ray M. Drulev
Address(Number and Street) Company
Fort Branch, IN 47648 812-753-4975 drulev(5insiohtbb.com
City,State,and ZIP Code Telephone Number E-mail
CE SE LLER(5)`/,GRANTOR(S)L ,a• - , . c`-3 - -r .. 7 - 7-7--:=7.-777:.--.
Micki R I emke Vicki I Reinhart
Seller I-Name as appears on conveyance document Seller 22--Name as appears on conveyance document
7772 E Edwards I ane J U 5- Ai Ci►'firGA
Address(Number and Street) Addres (Number and Street) �' y/��
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and ompl-teas re,uired ,y law,and'sit_ -pared in accordance with IC 6-1. 5.5,"Real Prq(lerty Sale t' :sure Act".p I libotte -11
,gnam : - / Signatur Seller r
„',' ; jj,- D- 1 T Vicki L 'inhart Dec 3VV-2013
Printed Name of Seller Sian Date(MM/DD/Yrvl) Printed Name of Seller Sign Date(MM/DD/YYYI)
!OBUYER(§)/ RAN,TEE(S)TAPP,EicATION}F,OMP,ROFERTMIAK)Enc-TroNS IDENTIEVALL4ITEMSYTHAVAP,pErt
Jerald R.Conner Alberta L. Conner
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
511 N. Polk Street 511$N. Polk Street
Address(Number and Street) Address(Number and Street)
Fort Branch, IN 47648 Fort Branch, IN 47648
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary Fl ❑ 3.Homestead
residence? Provide complete address of primary ❑ NI 4.Solar Energy Heatir / of i, S
residence,including county: ❑ J 5.Wind Power Device �L�
511 N Polk Street
Address(Number and Street) ❑ fl 6.Hydroelectric Power D 4q$ 2 2 2014
Fort Branch. IN 4764 Gibson ❑ Fl 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ Ig 8.1s this property ares-e: tial roe •: ?
❑ 0 2.Does the buyer have a homestead in Indiana to be , ' yrltljj;
vacated for this residence? If yes,provide ❑ 0 .Would you likampsyve r S -nts for this
complete address of residence being vacated, property via e-mail?(Provide con aekrbgnition
/including county: below.Please see instructions for more information.
Not available in all counties.)
Address(Number and Street) c3 G- / Z 6,-9 00 0 la -[3o
2 4-/ ./.3- -9 0/ 0 0 I 08.6 Oa L-
City,State ZIP Code County
Primary property owner contact name E-mail
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