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INDIANA SALES DISCLOSURE FORM SOF ID:
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EUGENE R LILLY
Preparer of the Sales Disclosure Form t21-4 i !7r,tJT
304 VALLEYDAL E DRIVE T1i1e !
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Address(Number and Street) Company - /�( L,
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NEW ALBANY IN 47150 Yl /
City.Stare.and ZIP Cade on /mb — L( C- r� C/ C)
Telephone.Number E-mail
iE.'.SELLER(5)%GRANTOR(S77 . itta T�+ +a Y r 1:, '�-- t— ..�a
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Seller l-h}�rrir `,5�ars'tMCeyvnce d men[
1JJ1''Ut� �I ALL EYE)AL ER Seller 2Name as appears on conveyance dxument
Address Az't-oALra4N Y 1 N 4 71 0 Address(Number and Street)'
and complete as required by llaaw,and is prepared in accordance with IC 6-1,1-5.5, "Real Property Sales Disclosure Act".
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Signoo Seller • Signature of Seller
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Printed Name of Seller ' Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/OD/YYYI)
F.BUYER(SW GRANTEE(S)-,1PPLICATIOIV:F.OR'P.YtTa-R'kr&J CVEp(1CT1OIK DEN:TIEY,A liTI PEMS THAZIAPPLY, ; xy 1
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Buyer 1-Name os appears an conveyance document Buyer 2-Name as appears on conveyance document
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Address(Number and Street) Address(Number and Street)
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TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALI.OF THOSE THAT APPLY. MAY 0 L 1W4
YES NO CONDITION NO COh'DITIO?1
tJ ❑ 1.Will this property be the buyer's primary C Z [ 3.Homestead aiwwco_y
residence? Provide complete address of primary Energy g/�g1gwgNT' y AUDITOR
residence,including county: ❑ 4.Solar Ener Heatin
*/ ,( 1-1 ri. R, ❑ Et S.Wind Power Device
Address 'umberandStreet) ❑ 3- 6.Hydroelectric Power Device
I 4/u ic.F72'.0 I A , 1176 711 &I "r?,SaA-) ❑ 3 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Cade County
3 I ❑ 3 8.Is this property a residential rental property?
Bi 2.Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes,provide ❑ Q- 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)
Ory,State21P Code t-0—Ia-o93ov---000. 03,/ oda
County
Primary property owner contact name E-mail