Homestead_Shoultz INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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J. Robert Kinkle Attorney
Preparer of the Sales Disclosure Form Title
219 N. Hart Street, PO Box 13 Hall, Partenheimer& Kinkle
Address(Number and Street) Company
Princeton, IN 47670 812-386-0050 jrkinkle@hpk-law.com
City,State,and ZIP Code Telephone Number E-mail
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Samantha E. Shoultz
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
13231 E 200 S
Address(Number and Street) Address(Number and Street)
Oakland City, IN 47660
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".
'IA OA iti.VCOLA— 114_1-X/ft
/ Signature of Seller 6 Signature of Seller
Samantha E. Shoultz 04/01/2015
Printed Name of Seller Sian Date(M)4/00/19.17) Printed Name of Seller Sian Date(Mn/Do/M'?)
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Jeremy B. Shoultz
Buyer 1•Name as appears on conveyance document Buyer 2-Name as appears an conveyance document ,,"
2838 N SR 65
-...-
Address(Number and Street) Address(Number and Street) •
4
Patoka, IN 47666 • 1
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THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APP0LY?4,9),
YES NO CONDITION YES NO CONDITION 14/
Vb..
12 D 1.Will this property be the buyer's primary al 0 3.Homestead
residence? Provide complete address of primary D tg 4.Solar Energy Heating/Cooling System
residence,including county:
lij tg 5.Wind Power Device
Address(Number and Street) D al 6.Hydroelectric Power Device
ID 12 7.Geothermal Energy Heating/Cooling Device
City,Stale ZIP Code County
ID tg 8.Is this property a residential rental property?
al 12 2.Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes,provide D 0 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.
same address Not available in all counties.)
Address(Number and Street)
Ot-os-g 8- id!) -oev. 9- 0a9 2
City,State ZIP Code County
Primary property owner contact name E-mail