HomeMy WebLinkAboutHomestead_Brickey • INDIANA SALES DISCLOSURE FORM 5DF ID: Page 2
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Prepares of the Sales Disclosure Form Title
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Address(Number end Street) Company
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6 State,and ZIPCoded . Telephone dumber E-mail
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Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
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Address(Number and Street) Address(Number and Street)
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Und, penalties f p ury,I h•reby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
an I 4 mplete as q I ed iy I. v,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
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I Signature of Seller
ate s Name°Tidier Sian ate(At Zoo/WM Printed Name or Seller Sian Date DDITADATTY1
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13well I-Name as appears on conveyance document Buyer?-Nome as appears on conveyance document
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Adds-as(Number and Street
,.,) Address(Number and Street)
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City.State.and ZIP Code City State,and ZIP Code
Oat i 1 arl d C. i +1/4.1 __t PV 1-1-'1/0400
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Telephone Number E-mail Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT1462 0 20 14
YES/ NO CONDITION YE NO CONDITION
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9 1.Will this property be the buyer's primary 9 3.Homestead ulie
residence? Provide complete address of primary 9 ZP 4.Solar EnergylMaitg ragsyktertioR
residence, including county:
a 0 S. Wcs+ 5-1-ree4- 9 R.- S.Wind Power Device
Atoa•Nu4lb,rancilZeet).-. .
I 0, (.- 4- --r-Pi 11-7(0 4 0
i y I, 0 cfr 6.Hydroelectric Power Device
0 V 7.Geothermal Energy Heating/Cooling Device
Ciry,State li P Code County
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9 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 0 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)
a-11-1-lig—30 3—DO
City.State ZIP Code County
Primary property owner contact name E-mail
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