Homestead_Davids INDIANA SAI.,ES DISCLOSURE FORM SDP 1D: Page 2
3:14EPARER ___ y .g. 3 E F - z .+
James S.Forcum — Attorney at Law
Preparer of the So its Disclosure Form Title
Post Office Box 430 Forcum&Forbes,LLP
Address(Number and Street) Company
Hartford City, •.Y 47348 765-348-1858
City,State,and ZIP Code Telephone Number E-mail
))E.'SBLLER(5)/CRANTOR(S)
MR RR Inc, Ry Richard W Smith President
Seller 1 Name as appears on conveyance document Seller 2-Name as appears on conveyance document
17860 South Sunset Drive
Address(Number and Street) Address(Number and Street)
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 r tilted by law,and is prepared in accordance with IC 6-1.1-5,5,"Real Property Sales Disclosure Act".
_ K.,.-
Signature of Seller Signature ofSeller
Richard W.Smith.President
Printed Name ofSeller Sign Date(MM/DD/YYY)1 Printed Name of Seller Stan Date(MN/DD/YITY)
WtBUYERISI/GRANTEE(SMAPPLICATIONTORIPROPERT.YEAkDEDUCTIONS41DENTIETALLITEMSTIHAVAF!PLYMIRM-
Greo Davids
Buyer l-Name as appears an conveyance document Buyer 2-Name as appears on conveyance dot Ry®
504 P�
East Gibson Street
Address ress(Number and Street) Address(Number and Street)
Haubstadt,IN 47639 JA
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR TIIIS PROPERTY.IDENTIFY ALL OF TNt15F9( '
YES NO CONDITION YES NO CONDITION OUNTt.
0 ❑ 1.Will this property be the buyer's primary ❑ 3.Homestead AVO(TOR
residence? Provide complete address of primary ❑ 0 4•Solar Energy Heating/Cooling System
residence,including county:
5 ❑
oL1 E C ; bSon 5.Wind Power Device
Address(Number ondStreet) ❑ PA 6.Hydroelectric Power Device
lFa b4ltae- Sr H 7 3 9 6:bson
❑ 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ Q 2.Does the buyer have a homestead in Indiana to be ❑ 0 B.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ TA 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 Coulrties)
Address(Number and Street) �y�*� 1 /� ,s�o
County d q(,1/—Jo " C.Cti-L o /— t90 /
City,State ZIP Code Primary property roP tY owner contact name E-mail