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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER CONNIE HOWARD COMMERCIAL OPERATIONS ASSISTANT
Preparer of the Sales Disclosure Form Title
2227 ST. RT. 256 SUITE OB VALMER LAND TITLE AGENCY LLC
Address(Number and Street) Company
REYNOLDSBURG, OHIO . 43068 614-860-0005
City,State and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTER(S) - - - -
T CORP.
Seller I-Name m appears on con veyance doc•..er.- Seller 1.Name as appears on conveyance document
\1011 w 100 s C C1iN1i;AS 1 D{11L4r%%2
`Aqd�dress(Number and Street) Address(Number and Street)
1A(�lxhs�'0.($3' _1\ `\m 3,
Telephone Number Sancti
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".
�/,-,(,rte )//. 11ii1-6i,/u.✓ Vied/
Signature of Seller Signature of Seller
CYNTHIA M. SHOEMAKER, TREAS. 12/19/13
Printed Nome o(Sdler OF T CORP. Sian Date(NY/DD/YYYY) Printed Name of Seller Sign Date(MUDD/YY/n
F.BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS,IDENTIFY.ALL ITEMS THAT'APPLY':`.'tsar,.='_ -:'.-:-d' -:
DOUGLAS A. SCHWARTZ ANGELA M. SCHWARTZ
Buyer 1•Name as appears on conveyance document Buyer 1.Name as appears on conveyance documer.:
625 WILSON SQUARE 625 WILSON SQUARE
Address(Number and Street) Address(Number and Street)
ELBERFELD, IN 47639 ELBERFELD, IN 47639
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 g '�
ca ❑ 1.Will this property be the buyer's primary Ik3 ❑ 3.Homestead telt
residence? Provide complete address of primary ❑ FS 4.Solar Energy Heating/Cooling System
residence,including county: ❑ ® S.Wind Power DevisAN 2 8 2014
Address(Number and Street) ❑ (?C 6.Hydroelectric Power Device
❑ ® 7.Geothermal Enervt eati •i - (ng Device
City,State ZIPCode County 1e, verir.
❑ LN 8.Is this prc rty� • :en r -'pi�®I�opty?
❑ l9( 2.Does the buyer have a homestead in Indiana to be ��SS N •u
vacated for this residence? If yes,provide ❑ IN 9.Would yo o 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)
c26,-N--fl-3i-Woo-oar. $gaol
City,State ZIP Code County
Primary property owner contact name Email