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Homestead_Doerner
/i�ISDIANA SALES DISCLOSURE FORM SDFID SDO ID 1796637 Pages D.PREPARER Bryceann Cutsinger Preparer of the Saks Darksare Form Title 226 W.Broadway St. Broadway Tale,Inc. Address plumber and Street) Compaq Princeton.IN 47670- 812-386-1687 samantha.b8®ms.twcbc.enm city.State,and ZIP Code Telephone Number C-cast ,. . . E.SELLER[S)/GRANTOR{S) John D.Hurst Monica R.Hurst Seller 1.Name as appears on conveyance document Seller?-Name as appears on conveyance dacumenl 3466 Bowen Rd. 3466 Bowen Rd. Address(Number and&rem) Address(Number and Street) Claxton.GA 30417- Claxton,GA 30417- Under penalties of p ry,l hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete as r law,and Is prepared in accordance with • 1.1-5.5,'Rea Pre ■erty Sales Disclosure Act". Signature of Seiler / of —�p� ✓ 7s l , t- 1)L '`j/. ;' /1 arc �— 1 fill_ /y, ♦6 r"A N • V\/IM1 Cnn Md INU# r Pinod A•nenn NCA, Gn"Ilne /Yuma F.BUYER(S)/GRAN E(S)-APPLICATION FOR PROPERTY T• F i t s ' - : .1 TIFY ALL ITEMS THAT APPLY Mitchell Dale Tessa it Doemer appears on conveyance document ----- -. .. ,•• • m conveyance document 6165 E.500 N. 6165 E.500 N. Addcisco.IN oaM9-ree:l Address(Number IN 4764 eF'ILE (( Francisco.IN 47649- Frandsen,IN 47649- ■nlr•'1, �r■!/■ THE SALES DISCLOSURE FORM MAY OE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROP :o + - OF E THAT APPLY. YES NO CONDITION YES NO CONDITION © ❑ 1.Will this property be the buyer's primary ► 1 j 3.Homeste-r i i/•MNi •residence? Provide complete address of primary ❑ © 4,Sotw§s 967� TD(, Ja% residence,including county: ❑ 6165 E 500 N. S.Wind Power Device Address(Number and Street) ❑ © 6.Hydroelectric Power Device Francisco.IN 47649 GIBSON ❑ © 7.Geothermal Energy Heating/Cooling Device City.State ZIP Code County © ❑ 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.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. 108 S.CROSS ST. Not available in all counties) •//1 Address ,IN 47649 649ven) ./-a ax /6 O// Francisco,IN 47649 GIBBON (//�(/(/ aty,State ZIP Code Caunry Primly property owner contact name E.m/l