Homestead_Chumley i ✓
,i1ANA SALES DISCLOSURE FORM SDF ID: Page 2
"D.PREP ER %. '
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Prepares the Sales Disclosure Form Tide
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Address(Num rand5treet) (AU) 3`w 147.-770a) Company(t)161.14000 •
City,State,and ZIPCode Telephone Numbe
E-mail•
E.SELLER(S)/GRANTOR(S). • ' - •_i . ' .' . r ,' -
JFFFRFYS COOPER DONNA I COOPER
Seller l- 'ame as wen conveyance day ent Sell 2-Name as appears on conveyance document
iS C(P COY - StQ.-vm_-ey
ress(Number and Street) Address(Number and Street)
tin n11)n `(1(0-70
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
As.and(c�o�!�(�plete as required�by�law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
_.....,
Agno r Seller, 0 Sig azure of Seller
JEFFREY S COOPFR 05/99/2015 DONNA L COOPFR 051920015
Printed Name of Seller Sian Date(MM/Do/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYI')
F.BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL:ITEMS THAT PPLY
m.
DEVIN M.CHUMLEY ---NNN
Buy�al.Name as o,^,pears on CO�once document Buyer 2-Name as appears on conveyance daume . ab
Addr
ruo li ber and Street)^u CU.k. IYh_ i-iI Address(,Number and Street)
JUN 7
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLV.O(JM',Y/jr/,
YES NO CONDITION I YES NO CONDITION 'q tJ/(f
YES
1.Will this property be the buyer's primary W❑^/3.Homestead FOR
residence? Provide complete address of primary ❑ L" 4.Solar Energy Heating/Cooling System
residence 333 resideYnclu ing oyp ( ❑ 2' S.Wind Power Device
d,�JJJ � l raJ
Addr?(NNuum ran Stye ' 1.7 'i d � ❑ Er 6.Hydroelectric Power Device
`-i ❑ l� 7.Geothermal Energy Heating/Cooling Device
City, tate ZIP.ade County
El 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 ❑ LJ 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)
City,State ZIP Code County
9 G -/ -/b - 4°0 co/ 3o4/oa,7
Primary property owner contact name E-mail