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Homestead_Hulfachor INDIANA SALES DISCLOSURE FORM SDI:ID SDO ID 1793770 Page 2 D.PREPARER Bryceann N Cutsinger Prepare(of the Sales Disclosure Form Tide 226 E.Broadway St. • Broadway Ttle.Inc. Address(Number and Street) - Company Princeton.IN 47670- _ 555-555-5555 samantha.bti(gmw.twcbc.com CO:.State.and ZIP Code • - Telephone,Number E-mail E.SELLER(S)/GRANTOR(S) Jed A.Pollock Tonia R.Pollock Seger I Name u>appears on mnrryume document Seller Z.Nome as appears on conveyance document 401 Harding Avenue 401 Harding Avenue Adorns(Number and Street) Address(Number and Street) Princeton,IN 47670- Princeton. IN 47670- Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and comple s required by law,and is prepared in accordance with IC 6-1.1-5,5,"Real Property Sales Disclosure Act", Sig ,turea Seller Signature a51Seller �ttQ.2ol)CCg--- 5-29-1a-- �tzs nvo— Qol1oC- .- 5 't3-9 -1y Pr"red Nor,r.G., a-,M. vn Pd"r.A Vr, n(rAr Glom Orretr,.inn ivvvn yF.BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS- IDENTIFY ALL S�-F1 AP ("Jan/ Janet L.Hulfachor aeNmL D et t-name a.appears on conveyance document Buyer 2-Name as appears an conv.v e d I P.O.Box 90 Address(Number and Street) Address(Number and Street) MAY 3 0 2014 Princeton,IN 47670- THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. AUDI IGIR YES NO CONDITION YES O N © El 1.Will this property be the buyer's primary © ❑ 3.Homestead residence? Provide complete address of primary " U 4.Solar •nergy Heating/Cooling System residence,including county: ❑ 305 JOHNSON AVENUE 5.Wind Power Device Address(Number and Street) ❑ ❑ 6. Hydroelectric Power Device Princeton,IN 47670 GIBBON ❑ © 7.Geothermal Energy Heating/Cooling Device City,Stare ZIP Code County • ID in 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 ❑ ❑ 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. t awilubfc in aft Loom!e5.) Address(Number and Street) City.State ZIP Code County d6 -/2 - 08 - ;o3 -00/. 7.3 Y-oaf . e•rimer contact name