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Homestead_Moog
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D.PREPARER J�,f i% } �S _ cer l_ eparer of the Saies Disclosure Form Title U iMILI n 5f �D >o►5 C�� +5 T�-I-e eA. 4Int. Aadrerr(Number and Street) Company \\OSYJt' I N Lfl g a (9-4-S? I tel to City,State and ZIPCode Telephone Number E-mail E.SELLER(S)/GRANTOR(S) , k ijlic !f yard Om"• i1 . Seller l-Nam- appears one nveyance dacumen' Seller 2-Name as appears on conveyance lament x-1 D 1 U). Dodge, 1. Address(Number and Street) Address(Number and Street) Omaha NE I9A- Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge ankbekfkis true,correct and vi ete re uir by lae%rid is prepared in accordance with IC 6-1.1-5.5,"R al Pro y Sales DiM'eT6sure Act". Cb-rth. Q. /yr� (n.-�.t--Q '-)fz`-`� /OSO� Signature of Seller Cry , 1 f1..t � Signature of Seller eV UN Printed l ef5271Fr"'_ Sion Date(MM/OO/YYYY) I Printed Name a Seller .Si.l,tRbte(MM/OD/YYFY) CER(S)/GRANTEE(S)-A'' ICATIONFORPROPERTYTAX-DEDU a ` -:IDENTIFY s ' STHAT.APPLY . . t . w'.-t L- N�OI-Name as apnea. .. - eyan�aument .Rlir al ears, ears on ., I!!��ment Address(Number and Street en ress(tj^.ynd et) THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO-1[0=710N (-YES�I on CONDITION JUN 11 7014 IL_I I] ❑ 1.Will this property be the buyer's primary ❑ 3. Homestead residence? Provide complete address of primary ar .nergy Heating/ oJi S � side ndudi g county: ❑ S Wind Power Iraifl£ON COUNTY AUDITOR adjnY Address(Number and Street) �� ❑ 6.Hydroelectric Power Device ❑ 7.Geothermal Energy Heating/Cooling Device Cr ,State ZIP Code County ❑ 2.Does the buyer have a homestead in Indiana to be El © 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 \ includ co below.Please see instructions for more information. '5- " 'J . f.0 t_ Id Not available in all counties.) nddress(Numby and Street) a6-4?-g-,30043. .6.50-.00.21-/ ')" f ,�cz.7e.-, 7.11 u.,)-., it G ; 1,;0.-1 ((L -