HomeMy WebLinkAboutHomestead_Jolly (2)INDIANA SALES DISCLOSURE FORM SDF ID:� Page 2
D.PREPARER
f
reparer ofthe Sales Disclosure Farm Title
- vel
Address(h'umberand Street)
E -mail
E. SELLER(S)/GRANTOR(S) - _
K--
a rZx 0 77T, l Pr
Sg aspear , n conveyance document
Seller 2 -Name as appe rs on conveyance document
a�(-( t= id eve/
al(,, Lf J n .e4d< LPue
Addr s(A'umFerand Street)
Add'rejs(Number an Street)
l QZn -hon 0 � �t-7 cV (-(0
Ala2 /-e, , _/-� 117&o (O
Ciy, State, and ZIP Code
City, State, and ZIP Code
E -mail
Under pe alties o (perjury hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and co lete as quired y law, and is prepared in accordance with IC 1.1 -5.5, "Rea Pro ty Sales Disclosure Act ".
r-
1
Si not r Seller �nJ Si nature a eller
g
i �+t
PrintedlNam Si n Dale MM /DD Pdn[ed Name o Sell r Si n Date (MM DD
F. R S GRANTEE S -= AP (CATION. FOR PROPERTY TAX DEDUCTIONS- IDENTIFY ALL ITEMS THAT APPLY
Buyer] Name asappearsom mnveya ced ument
Buyer 2- Name as appears on conveyance document
E
s)
Address (Number and Street)
State, and ZIP Code
City, State, and ZIP Code
0Chy,
E -mail
I Telephone Number E -mail
TILE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
1'F.S NO CONDITION � NO CONDITIO.
❑ 1. Will this property be the buyer's primary
Z ❑ 3. Homestead
residence? Provide complete address of prima "
4. Solar gy Heating /Cooling System
residence, including county:
❑ S. Wind Power Device
(enter �p1
u-6'/
E] ® 6. Hydroelectric Power Device
Adg�rf ss(A'umberand5treet) /
Ff112%iYJ/I IN 7110
❑ [3 7. Geothermal Energy Heating /Cooling Device
��{{
❑ l� 8. Is this property a residential rental property?
City, State ZIP Code County
❑ 2. Does the buyer have a homestead in Indiana to be
X 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.)
- /o/
Address (Number and Sven)
City, State ZIP Code County
Primary property owner concoct name E -mail
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 ". (Note:
Spouse information, Social Security and Driver's License /Other numbers are not necessary if no Homestead Deduction is
being filed.)
h/AtOJ m- aPlg
Signature of Bl Signature ofBayer2/Spouse
uyer /)/
M , 0 09- 0`l1079
�l&ren
rinted. Legal Name ofBvyer l Sign Date(MM/DD/rYYY) Printed Legal Name of Bayer 2 15pouse Sign Date(MM/DD/YYYY)
Last 5 digits of Buyer l Driver's State Last 5 Digits of Social Security Number Last 5 digits oflluyer2 /Spouse Driver's State Last 5 Digits of5ocial Security
License /1D /Other Number Number License /ID /Other Number