Homestead_Smith (13) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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PrepareroftheSales Disclosure Form Title
ICI E us fJrC�G�t,iyvy 3d ,'cue —r- --tLite •
Address(Number and Saes) Company
..1-ieter^VI II 14,0 -{(x373— 2.N. 322 • ZZS 7
Ciry,State,and ZIP Code Telephone Number E-mail
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earn-u-s .rp Y-0.$ .
Seger I Name as a ;ear oonnn cc//oonn`v+eyvnc�dgcymgn ,n0( Seller 2-Name as appears on conveyance document
Addr Number an pears
{/�� y~/C'I,11/•JL`• �IC� Address(Number and Street)
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
- • • complete as equired by law,and is prepared in accordance wi • IC 6-1. -5. "Real Pro. rty Sales Disclosure Act".
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S• amre of Seger , • l i _I. Sign•-t of Seller I II
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Primed No, . Pm —.1.11.0•te(MM/DD/rrml Prined Name ofSed Y-n Date(NM/DD/MY)
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- I-Na•e• appears on co •nce document Buyer 2•Name os appears on conveyance docum
AddreesFbrt d5° )
THE Sr.l FS DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROP A c.• .". •a ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
I�I ❑ 1.Will this property be the buyer's primary E. ❑ 3.Homestead
residence? Provide complete address of primary a V , -e - ergy Heating/Cooling System
H-' r id ce,inc d ng cpunty:-
a�ll l(WJ 6t43 ❑ 5.Wind Power Device
dress(N tabor ndso- ❑ ❑✓ 6.Hydroelectric Power Device
jnd j. trip 31 is-Hosoc`
dress � ❑ Er 7.Geothermal Energy Heating/Cooling Device
Cy,irate ZlP Cade County
❑ 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: elow.Please see instructions for more information.
(03.19 S 5116 E Not available in all counties)
An
(Nu Street)64rekneL :raj 47&of d 61 106 tri"--brla -oS//-of40 0 /- 002S/
City,State Zino*Zino* County //
Primary properry owner conmct name - E-mail