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I\DIA\ASALF.SDISCLOSUREFOR\1 SDFID SDOID 728315 Page2
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Samantha L Cutsinger
'A'eyarer o(�he Saies Oisdosure Form TiJe
226 W. Broadvray Broatlway Title, Inc.
I Addres(NumberoiMSOee[J Compony
� Prince�on,IN47670-
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Seller i � 4'amevsnpyevrsom m�ve�vn�eJa'ument
5730 S 950 W
Add�ns(NUmberondSveeQ
Ovrensville, IN 47665
Shely L Heldt
Srllrr Z� Nome ns npp¢ors om m�viminie du�vmen�
5730 S 950 W
ACd.ess (A'umber and Sveey
Owensville, IN 47665
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Under penalties of pe 'Gry, t hereby certify [hat this Sales Disdosure, to the best of my knowledge and belie(, is true, correct
and cm lete as r iired by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
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- APPLICATION FOR PROPERTY T
Darin W Devrig J
�uyrrl��YVmen�^- ursonronveynnredavmen:
9208 W SR 165
Address (A'umber and Svere/
Owensville, IN 47665
,
6uyer? �,Yamr us nppevrs om m�vnanre dxumen[
ACdress (,Yumner vnd Srteet)
Ciry. Smre. and ZIPCate
THE 5,1LES UISCLOSURE FOR�1 MAY BE USED TO APPLY FOR CERTAIN DEOURIO,�'S FOR THIS PROPERTY. IDENTIF1' TLL OF THOSE THAT APPLI'.
X� � 1. Will chis properry be the buyer's primary C
residence? Provide complete address of primary
residence, induding tounty:
5730 S 950 W
aee��zs �n�m�� me s:.ee��
Owensville, IN 47665 GIBSON
Ciry.SmreZlPCOde Coun9.
�� ?. Does the buyer have a homestead in Indiana [o be
vacated for this residence? If yes, provide
comple[e address of residence being vacated,
including counp�:
Addrezs /,YUm6rr ar.dS✓cet)
Giry, Sma ZfPCode Counry
>i5 NO COADITIOY
Q � 3. Homesi
'�.ToTar 8nergy Heating/Cooling System
� Q 5. 4Yind Power Device
❑ Q 6. Hydroelectric Power Device
❑ Q 7. Geothermal F,nerey Heating/Cooling Device
� Q 8. Is [his properry a residential rental property?
� Q 9. �Vould you like co receive tax statements for this
properry via e-mail? (Provide conmct in%ormation
below. P/ense see instructions for more in%rmotion.
M1bt available in a!I counties.)
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Under penal[ies of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and wmplete as required by law, an� is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Ac[". [Note:
S use information, Social Security and Driver's Lirense/Other numbers are not necessary if no Homestead Deduction is
bei filed.)_ ,�, � � �� _
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