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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
Al-PREPAREWt -., r Z .< .. ke. ,_ Q`.� , . . _-;_
U•r:AvOtt 11PAIlrin —
Preparer of the Sales Disclosure Fen.. Title
230 U F Aakc
A res(Number and Street)
1 E-mail
-E SELLLER(Sl/GRANTOR(S) `a , . », r:T .. -. i- nY .r n- n ._` .. �
Kobtr+- L. l�vr.n `Vjr A-orn 14-QaQri.
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
23oi E lake Rd 0230Q F_- Lake !d
Ad (Number and Street) Add (Number and Street)
rn,tw 1-Dv, i, (06 7 O Mite f-n„ j5tl 1/74 20
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 C 6-1.1-5.5," al P operty Sales Disclosure Act".
6,.2e.,, —5 oc - 2-t- ,/.r% A
Sextet are of Seller l�" nature of Seiler
6ert- L" )-I-eaQrn OdIOR423.)y Ic.bria fieain•,( 06/0?1rt�/4r'
Printed flame of Seller Sign Date(MM/DD/YYYYI Printed Name ofSeller Sian Date(MM/DD/YYfY)
F:BUYHLZ(S)%GRANTFF,S..SL APPLICATIONT ORPROPERTYTAXDEDUCTIONS-.
-
TIE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY. '¢�
YES NO alNDmON /YES Nn n1NDrnoN - 1 �j A p 0 1.Will this property be the buyer's primary / N ❑ 3.Horn--•' .. tlg„l RjJu
residence? Provide complete address of rim "-
residence,including county: p �'
El n ,• r • •rgy •eating/Cooling System
/ 3S , /00 N ❑ 2 S.Wind Poweti UNvi$ 2014
dt(nosa(Number and Street) ❑ W 6.Hydroelectric Power Device
/'/'loath,., 1-A/ 1/7170 (/�rbso�
City,State ZIP Cade `� Couny, El R 7.Geothermr g/Cooling Device
❑ V. 2.Does the buyer have a hq d inirldi.r,. be ❑ ® 8.Is t® G Ig(pl�ppjtjey q property?
vacated for this resid e? f s,pI fA,-,l{_Ie ❑ ® 9.Would you like to receive tax statements for this
�i
complete address of r side
Tim
•g aefa property via e-mail?(Provide contact information
including county:
available
-f all counties) 38 ) _O � 7
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City,Sate VP Code /!_iii County (...776.7611.1-
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