Homestead_Ott INDIANA SALES DISCLOSURE FORM SDF ID: - Page 2
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Me(11.0 J +lard; Ma vk Owner •-..i.
Preparer of the Sales Disclosure Form Title
2_o6S. Wes-} St-
Address(Number and Street) Company
f&1-bK4 , J n) 47 (.,46 h12 -(06y - 733
Ciry,State,and ZIP Code Telephone Number E-mail
3E^SEL'LER(S)%GRANTOR(5)�.,?'+Y''-`A ct'.-...' '�•"``.R`4-�.-�!i�. L; .-,, i*s^,.}�v- -n;.;� ,w�_, .e Ea
. i -'?l'e�- � 4.i•,±,+.1.. ;.�?G�.:L'�'_€s3e'TZ: _i_- °'„F:r. ? 2_-3
Seller 1- me as appears on conveyance document Seller 2-Name as appears on conveyance document
1J AL-„,_—__ ),,
Address(Number and Streeti Address(Number and Street)
4 30 30 a it-a Ca ctMr`j Lai
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 IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller Signature of Seller
1 v N w II— tr 5 —Err•f-r T�
Time of Seller ion Date(MM/DD/YYYY) Printed Name of Seller Sian Date(b1H/DD/YYYn
C' API liICATIONi(ORI . OP,ERTY!TAX{DEDUCTIONS 'IDENTIFI'ALL 1TEMSTHATTAPtardiWV4Afk an Buyer2-Name as appears on conveyance document
Address(Number and Street) Address(Number and Street)
Pa to tkA a r1 y 7 4.66
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PRO• • . - - . THOSE THAT APPLY
YES NO CONDITION YES NO CONDITION
M ❑ 1.Will this property be the buyer's primary _ l2:1 El 3.Homestead JUL i2.2z U14
residence? Provide complete address of primary • A . ar nergy Heati Cooling Sys em
residence,including county: ❑ d 5.Wind Powee�exicN �
Z0C C`ESF- �,-,r VV cg�{LfitYAUDITOR
Address(Number and Street) ❑ L7 6.Hydroelectric Power
Pa to Ka / r,J 4-/76,6 6 �0;hs0tl ❑ 7,Geothermal Energy Heating/Cooling Device
City,State IP Code County
ET
❑ 2.Does the buyer have a homestead in Indiana to be ❑ 5.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.
Not available in all counties.)
Address(Number and Street)
Ciry,State ZIP Code County
CYO _ /dears/O/— God. /S -0d-6
Primary property owner contact name E-mail