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HomeMy WebLinkAboutHomestead_FugateNA\3 INDIANA ,SALES DISCLOSURE FORM SDFID SDO ID 718354 Pay;. t D.PREPARER C Barrett Prepare, ofthe Sales Duchunme Form Title 26 West Broadway Broadway Title. Inc. Addros(NumbermMSuvct) Company Princeton, IN 47670- E. SELLERS GRANTORS Shannon F GoocWn Seller I- Nume sappear, ear eanvesvme daemom Seller2 Numr osuCVeanon mnvawnceda'ument 3990 N 175 W Address (Number and Street) Address (Number and Street) Patoka, IN 47666 - 0,7,, Store, and ZIP. Code Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and comp t as required ky law, a d is repareIl in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act". S'a rur a '< er J`�— signalu.e ofsener 7 F. BUYERS GRANTEES - AP CATION -FOR PROPERTY TAX L DUCTIONS- IDENTIFYALLITEMSTHATAPPLY Christopher L Fugate Buyerl - Name as appears on canve}vn meat Buyer2 Name usappearvan conveyance document 3 Makemso r„ .,, Add,wuVUmberand Street) Princeton, IN 47670 - City,State .nndZlPCa:e City. State, and ZIP Code � Telephone Number E +n oil Tele horse Nwnber E-mail THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR 15 PROPERTY. IDENT F1' ALL OF THOSE THAT APPLY. YES NO CONDITION NO CONDITION x ❑ 1. Will this property be the buyer's primary ❑x ❑ 3. Homestead residence? Provide complete address of primary eating /Cooling System residence, including county: ❑ S. Wind Power Device 3990 N 175 W ❑ ❑ 6. Hydroelectric Power Device Address (Number and Street) Patoka, IN 47666 GIBBON ❑ © 7. Geothermal Energy Heating /Cooling Device ❑ © B. Is this property a residential rental property? Ciry, State ZIPCode County ® ❑ 2. Does the buyer have homestead in Indiana to be a 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 m tacks gcounty: below. Please see instructionsfor more information. lf � M S 0 A) Not available in all counties.) � Oa ' �j�( /� C /�)�/ V (/(J .✓ /�/ Pnmanpmperry orvner cormct name E -mail (AUmber and�5vrret "1��\ City, State ZIP Code County 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 bet og filed.) S,i%�a of R.' Al L Signature ofBeyer2lSpouse C.. 5Toayn L &5 7/ 6& e 2% Pooled Legal Nomea Boyer ]t 1 5(gn time IM,MIDDInli Pnntrd Legal Name of Bayer : /Spouse Sign Dote(.H.N /DD/ml) ® Lost 5 digits of Buyer l Driver's Stare Last S Digits of Social Security Number Lost 5 digits of Buyer 2 1Spouse Dover's State Last 5 DigitsofSocial5ecinty License /ID /Other Number Number license /ID /Other Number N