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Homestead_BrubakerC C r' ISDIANA SALES DISCLOSURE FORM SIDE ID SDO ID 714551 Page 2- D.PREPARER Samantha Cutsinger Preparer ofthe Soles Disclosure Farm Tide 226 W. Broadway Broadway Title, Inc. Andres, (Number and Sueet) Company Princeton, IN 47670- _ E.SELLER S GRANTOR CS) James H Bertram Jr. Seller 1 Name vs appevrs an ronvnvme darument Srflrrl Numr ns upyevn ern mnvpvme da'vrnem 409 W. Vine St. P.O. Box 222 Address (Number and Street) Address (Number and Street) Patoka, IN 47666- Clq; Sin re, and ZIP Code City, Suite, and ZIP Code tii4 rely hone Number E -mull Tele hone Number 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 ". . rmr.-- .rller A 2 es APPLICATION FOR PROPERTY NS- IDENTI L ITEMS THAT APPLY ITimothy Brubaker Lori Brubaker Buyrrl -NCme ns oppea unvewna davmen: Buyer? Nomeasolepm '. mnve.mnredoeument 227 S. Broshears CL ears Ct. Address (Number and Street) Address (Number and Street) Oakland City, IN 47660- Oakland City, IN 47660- City. Stare. and ZIP Carve City, Stu¢. and ZIP Cafe (� )J'A-' W fi Tde hone Number E -mail Tele hone Number E -mail THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS 15 PR THOSE THAT APPLY. YES NO CONDITION YES NO CONDITION x❑ ❑ 1. Will this property be the buyer's primay X ❑ 3. Homest residence? Provide complete address of primary ❑ 4, Solar Energy Beating /Cooling System residence, including county: ❑ ❑ 5. Wind Power Device 411 W. VINE ST. ❑ © 6. Hydroelectric Power Device Address (Number and Street) Patoka, IN 47666 GIBSON ❑ ❑ 7. Geothermal Energy Heating /Cooling Device ❑ © 8. Is this property a residential rental property? City. S ute ZIP Code Counry ® 7 2. Does the buyer have a homestead in Indiana to be 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 incl in couny: below. Please see instructionsfor more information. 2 S S EWS C) Nor available in all counties.) Ad en( Vinberam(Street) 41 ) '—City, State ZIP Code Counry — Nimary preper0,inviter contort name Email 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 beingfile CIA n yftye ec;li Il�lI Signolvre oJBaye I 5 gature oJBy¢r2 /5 use _ bcr tl- �/ (1rr , TISc -, -I/ L 0 r r0hQLeI(- ,�F?- // Printed Legal-Name// szye, I Sign D9tetMM 1D01YYT11 Buyer ? /Spose Sign Date tnv /DU/mYI -. ' Security Number Lost 5 digits of Buyer 2 1Spouse Driver's State Lon SDigi[sofsoriol Security License /lD /Other Number Number License/lD /Other ,Number