Homestead_Heavrin INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
tD'>PREPARER<_, ' - - . ._•
(I ruin-ll I�ect0(, q Pr re of the Sales Du o e Fa Title
lC; ��{ ( S
?dress(Number an Street) �- Com ny
?dress(Number Ion to (/ 74 0 /2-Y 3--6r Seo
Ciry,State,and ZIP Code 2 Telephone Number E-mail
E..SELLERS)/GRANTOR(S)
Seller 1-Name as appears on conveyance document I� Seller 2-N'ame as appears on conveyance document
R. hat v,2-1;=#-I:=1 . ..--7,c) F'�'c-ir)i_ V IC/og/A. 1. G'J-e-AVki✓
Address(Number and Street) Address(Number and Street)
o LAx �r I fi...3oii -t
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my kno g an ef,is true,correct
andco/co��mplleeette as requir d by law,and is prepared in accordance with 6-1.1-5.5,"Real Pro.erty Sales Disclosure Act".
Signature of Seller lit li••-reofSeller iFieolJ COONTY:AUDITOR
rCo cR! L . 14 ah . ri /11,+C Of LCIL 11
PrintedNome of cam. _ . Sian Dote(M,H/DO/YYYY) rinted Name of Seller Sian Date(MM/DD/YYYI'1
kr-BUYER S GRANTEE S -APPLICATION ORFROPERT- AX DEDUCTIONS-IDENTIFY ALL ITEMS THAT •PPLY
C • ' a 1 ii - 'C 7 -. . eiralgO .Sinre
Buyer 2-Name as appea• op.Gonveyance document
C / G opru r e A. (%(t) 9
Street) c-c �'.
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
Y
ES 0 CONDITION V I YES-----NO—CONDTION
( ❑ 1.Will this property be the buyer's primary ❑ 3.Homestead)
residence? Provide complete address of primary rterff Heating/Cooling System
residence,including county: ❑ (rl 5.Wind Power Device
Address(Number and Street) ❑ 6.Hydroelectric Power Device
❑ 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ (a 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 ❑ gi 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: elow.Please see instructions for- e information.
Not available in all counties.)
Address(Number and Street)
02-6 'l.2 - p7 - / o/ (it"N . $,z_ / -Od-B
City,State ZIP Code County
prhROR.yrapem' mtt ame E-maikt