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Homestead_Griffin INDIANA SALES DISCLOSURE FORM SUE ID SDO ID 1800526 _ Page 2 D.PREPARER - _ • • Kimberly A.Lewis Office Manager Preparer of the Sales Disclosure Form Title 226 W.Broadway Broadway Title,Inc. Address(Number and Street) Company Princeton,IN 47670- 812-386-1687 kim.bti@mw.twcbc.com City.State.and ZIP Code Telephone Number E-mail E.SELLER(S)/GRANTOR(S) - - ' Rollin Kenneth Robinson Bettye Ann Robinson Seller I-Name as appeals on conveyance document Seller 2-Name as appears on conveyance document 10521 W SR 165 10521 W SR 165 Address(Number and Street) Address(Number and Street) Owensville,IN 47665- Owensville,IN 47665- 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". aeatne...010..—iYi-+ 3.,r1 nta G.-v-■ 6Lo./,.,,.nJ...- Signature ofSeller Signature of eller /&/ftu Azescei •r IS4)-scn /6 ZB-- /It 4e-rty'e 4..nf /201.,:r,cn1 ie/zcihil Pd-rd Wm,meaner o"n nero,wsu innnvvn Rfineda mP nfcel'er firm n"l;,v real" F.BUYER(S)/GRANTEE(S)-•APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS EFIATr' P$ptY ¶y , David J.Griffin Danita L.Griffin ' 1 N J {:J gi .. as appears on conveyance document Buyer 2-Name as appears on conveyance document 893051125W 893051125W OCT 29 20 i4 Address(Number and Street) Address(Number and Street) Owensville,IN 47665- Owensville,IN 47665- THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION US- NO—COYDI i IU. © ❑ 1.Will this property be the buyer's primary ( © ❑ 3.Homestead residence? Provide complete address of primary u Tu 4.Solar Energy Heating/Cooling System residence,including county: ❑ 10521 W SR 165 5.Wind Power Device Address(Number and Street) ❑ © 6.Hydroelectric Power Device Owensville,IN 47665 GIBBON ❑ © 7.Geothermal Energy Heating/Cooling Device City.State ZIP Code County N ❑ 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: •• e n- • et • •• ' . 'ens for more information. ���(� S Not available in all counties.) revs Number and Street) � e, Ia. r 11:1 . .2L-/7 - 17 - ?-OD - 0oi• 5//-oJ- City,State ZIP Code County -• owner contort name E- ail