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Homestead_Hull (2)
INDIANA SALES DISCLOSURE FORM SOF ID: Page 2 D.PREPARER`.. SHERI L.GREENE Preparer of the Sales Disclosure Form Title 1122 E OHIO ST Address(Number and Street) Company PRINCETON,IN 47670 812-664-1005 City,State,and ZIP Code Telephone Number E-mail • E.SELLERS)/GRANTOR(S) c- .-. - - JOHN DAVID CHAMBERLAIN Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 711 N CHERRY LN (PO BOX 7711 Address(Number and Street) Address(Number and Street) PATOKA IN 47666 -_ 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 corn lete as required by lbw,an cJ is pr pared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". ,calf (�!(�L LG/`G t� l�—,v1i vr+' Cigna are of5e¢r Signature of Seller IOHN DAVID CHAMBER! AIN 3 't 17014 Sign Date MM/o0 Printed Name Seller Sian Date(MM/00/WM Printed Name of Seller 3 ( /vFl�7 f F.BUYER(S)/GRANTEE(S)T-APPLICATION;FORPROPERTYTAX• THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FORTIIIS PROPERTY. IDENTIFY ALL OFTIIOSETH.4"j'4 COUNTY AUDITOR YES NO CONDITION ES NO CON TION 0 ❑ 1.Will this property be the buyer's primary (71 ❑ 3,Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Beating/Cooling System n residence,A ,j {i in county:_%U ❑ 12 5,Wind Power Device rX d/ N nd ffCC KK ❑ o 6. Hydroelectric Power Device Address(Number and Stre� n P/TO K A, 1/✓ `4 7 lo(o to a t is o.✓ ❑ ) 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ ig 8.1s this property a residential rental property? ❑ ❑ 2.Does the buyer have a homestead in Indiana to be vacated for this residence? If yes,provide ❑ g 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) Kco-O - it 303_000.a(4,8'--o City,State ZIP Code County Primary properrttyowner�contact name E-mail