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I tl IANA SALES DISCLOSURE FORM SDF ID: &- Page 2
1•eparer of the Sales Disclosure Fgrm' Tide
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Address(Number and Street) Company
PUIP1� . tom L 767J cSI — ,6 �Gcf67)
Ci ,State,and ZIP Code r,Telepaskrii�yHw Number E-mail
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E.S LLER S GRANTORS {a? .:. .., I t , ".tt 11141-i..: ...;:i.:',''''•••, --
1-Warne ak6ppears o court ante document Sel/tl`2- ame as appears on conveyance document
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Tess(Number and5treet) - Addies(Number and Street)
rt�6c-kVP) l t �7670 EaZjef&n , TN 'I 11/,y6 \rl-�
Under penalties of perjury,I hereby certify that this Sales D4 o the best of my knowledge and belief,is true,correct
and complete as Ire/q�uirreed by law,and is prepared in accordance w`1 IC 6-1.1-5.5,"RReeal Property Di closure Act".
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Signature of Seller Signature• Seller (� r
Mir,kacl 0 , O2�$ Dti �n./ # ,(0a: rt> l- -nci?, S• l-(C`-`---S
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Nuke ofSeller Sign Date(MM/DD/YYYY)
F.,BUYER(S) GRANTEELI.-APPLICATION,FOR PROPERTY TAXDEDUCTIONS-,IDENTIFY ALL IT THAT APPLY•. .
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+ Buyer appears y
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Addr;ct BNrmbar and Sant, Address(Number and Street) MAR 3 0 2015
,,. `�c'c11, -N -- ti 767, )
SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY.
1 NO CONDITION s _YES
❑ 1.Will this property be the buyer's primary s - 9 3.Homestead
residence? Provide complete address of primary •R� 4.Solar Energy Heating/Cooling System
residence,including county: 1 ❑
5.Wind Power Device
Address(Number and Street) r 9 E 6.Hydroelectric Power Device
11{-€22 u r w cc (tih5 P', _
❑ a";.0. 7.Geothermal Energy Heating/Cooling Device
City.State ZIPCode County
❑ 2.Does the buyer have a homestead in Indiana to be , _?�0 r K`- 8.-.Is this property a residential rental property?
tut""'^" 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)
ii a'j - /d -07-/0 Y- 000 .576 -oa8
Iv,State ZIP Code County
Primary property owner contact name E-mail
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