Homestead_Busch INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
J. Robert Kinkle Attorney
Preparer of the Sales Disclosure Form Tide
219 N Hart St. Hall,Partenheimer 8 Kinkle
Address(Number and Street) Company
Princeton, IN 47670 812-386-0050 irkinkle(dhpk-law.com
City,State,and ZIP Code Telephone Number E-mail Charles W Heflin
Seller I•Name as appears on conveyance document Seller 2-Name as appears on conveyance document
404 W Cottonwood St
Address(Number and Street) Address(Number and Street)
Patnka IN 47666
Under penalties of perjury, 1 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".
t, ) W l't c�j1
Signature of Seller Signature of Seller
Charles W Heflin ,1�
hinted Name of Seller / Sion Date(MM/DD/YO'Y) Printed Name of Seller Sian Date(MM/ODflmI
F.;BUYER(S)/GRANTEE(S)`_ARPLI CATION_FOR,PROPERTY=TAXDEDUGTIONS )DENTIFY ALL IT _ • Art'APry Y,j_ _ _ _
Scott Busch
Buyer I-Name as appears an conveyance document Buyer 2-Name as appears on conveyance document
6111 W 200 N APR 6 2015
Address(Number and Street) Address(Number and Street)
Patoka, IN 47666
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION a. s CONDITION
❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary • FA 4.Solar Energy Heating/Cooling System
residence,including county:
404 W Cottonwood St ❑ tg 5.Wind Power Device
Address(Number and Street) ❑ Q 6.Hydroelectric Power Device
Patoka, IN 47666 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ 0 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.
Not available in all counties.)
Address(Number and Street) tR/_ O V—a5/o/_000 %L//_OdQ
City,State ZIP Code County lEJ 7
Primary property owner contact name E-mail
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