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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
yD.PREP. ikliik �4 o7,flir e`a'rir c:y '_c-r t.i?-_.'_ __ .i-6.- "_',tea -f: F`. -LaFr' 'r z
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Preparer of the Sales Disc! #re Form Title
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ess(Narand Street etyti d r.1) Company/
City,State,and ZlP Code �� y S7 Telephone Number E-mail
EtSEELER(S`.GRANTOR( Nik v' �Zt 2 ."s.'3x3 r t:. "t, . - :: :.>> TX' fef' n :4.
Seller l-Name as op•-•rs on am, •nce•oe ent Seller 2-Name as appears n veyancedacumen
0690 s conveyance
Addreis(Num•-r and Stre t)
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A. I ► e, n Li7aod AddrnN4mrind Strreetr)
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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 b law,and is prepared in accordance with, C 6-1.1-5.5,"Real Property Sales Disclosure Act".
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Signature of Seller Si nature of Seller o
Printed Name of Seller S�Date(MMDD/YYYt) Printed Name of Seller �� �� Sian Date(H.v(DOmTYY(
F::BUYER(S)/GRANTEE S)&APPLICATION FOR PRDPERTY.ITAX DEDUCTIONS=`lDENTIFY.ALL:ITEMSTHAT AP$LYjst r t
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r on conveyance document Buyer 2-Name as appears on conveyance document
Adrpss(Number an tree[ Address(Number and Street)
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THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAEAFsPL ,
YES NO CONDITION I YES NO CONDITION AAAA
El 1.Will this property be the buyer's primary ^ j ❑ 3. Homestead AUG 5 2014
residence? Provide complete address of primary l\
residence includinh county: ❑ - 4.Solar Energy Heating/Cooling System
iti 1 S T • trlfl I N ❑ S.Wind Power Device
Addrar(NUmber and Stre t) �.. ❑ 6. Hydroelectric P
QR R vi t\ok \ -t 4)-7/.„-,0 C�( hSV� �Wd?jW()UNITY AUDITOR
ty,State ZIP Code ((( County ❑ • 7.Geothermal Energy Heating/Cooling Device
❑ 2.Does the buyer have a homestead in Indiana to be ❑ $•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)
aC: — ILI—( 8-;t3 . ( —oo ,
City,State ZIP Code County
Primary property owner contact name E-mail
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