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Homestead_HurstINDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
;D-�PREPARER � .F�`-��.-.si'7�."`� L�":'�"'�':,.�,��.Ras: �_ ;d -_ 'LF �' u- ' _ � r Y,_-'•a- ° .. tr-'� � .
- �wC_. .
- J. Robert Kinkle Attomev at Law
Preparero/rheSalaDiulosureForm Title
219 N. Hart Street Hall. Partenheimer & Kinkte
Addras (Numbm and Street)
Ciry, Smle, andLPCode Tdryhone Number E-mail
�E:SE�I:ERS GRANTOR ��-A-��.'�'.�+i'�a�'�ti �+r��..i�F.,.� r.i:::4�.s.'`,u+","�:�'�� � ��'�'� :o,:;? �i';,^.'.;..-�S•x''a.
Shirley J. Basham
Sellw 1- Nome as appears m tonveyvnce document Sd/rr2 - Nameas appmrs m cvnveyance dacumml
5200 S_450 W_
Address(Numberond5veet) Add�(Numberand5bee[)
Owensville. IN 47665
E-mvll Tde honeNUmWi E�mvi/
Under penalties of perjury, t 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".
gnu�sf�areu/.sdl � s�gnnmren/sd�n
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PnntedNomeo Sd/er Si . Dom MM DO Pr(ntedNameo Stlltr Si nDate NM/Do
`.F:BUYER S' GRANTEE S �:ABPLICATIONIFORPROPER7;YTAX•DEDUCTIONS=IDENTtFY.ALL'ITEMSTHATAPPLYI-' ' '
Chnsty L Hurst
Buyc 1- Nameas appwrs on ronveyan�edrcvmen[ Buya 2- Name atappmrs om m�vryonre dacvmm[
804 Jefferson
Addres (Nvmberand Stree[) Addim (Numbrr andStree[)
ewbu h IN 47630
Ciry.Smte, ondl/PCade C/ry.5mtq and ZIPCade
£-mail Tde honeNum6er E-mail
THE SALFS DISdOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUGTIONS FOR TNIS PROPERTY. IDEYTIFY ALL Of THOSE THAT APPLY.
YFS NO [ONDRION YES NO CONDITION
�✓ � 1. Will this property be the buyer's primary ❑✓ ❑ 3. Homes[ead
residence? Provide complete address of primary � � 4. Solar Energy Heatlng/Cooling Sys[em
residence, including county:
f+220 S 450 W ❑ ❑✓ 5. Wind Power Device
Addras(Numberand5tree[) . � ❑✓ 6. Hydroelectri[ Power Device
Owensville IN 47665 Gibson � Q 7, Geothermal Energy Heating/Cooling Device
Ciry, SW ce ZIPCOde Caunry
Q� 2. Does the buyer have a homestead in Indiana to be � � 8• �s this property a residential rental property?
vacated for this residence? If yes, provide ❑ ❑� 9• Would you like to receive [ax statements for this
comple[e address of residence being vacated, property via e-mail? (Provide contact information
including county: -. below. Please see instructions for more injormation.
804 Jefferson � A ot a�va/ilj!ble in all munties.) �J�
Address (Nvmber and Stree[) �r f� �/�O C�� 3�U +�/� ',�a �'��`(
Newburqh IN47630 Warrick ����si'u 1.... F�ia✓s�
Ciry, Smte ZIPCOde Counry
Pomaryympe�ryownermnmctname E-mail
Under penalties of perjury, l hereby certify that [his Sales Disclosure, to [he best of my knowledge and belief, is tne, correct
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". [Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deducdon is
bein led.) �
5 ry rJguy r� '� I I AgnaNreo(Buya2/Spouse
M1
v,;�redDa�
Las[SdigiGSO(BuyerlDriver's Smte LastSDigi[sofSocialSecuriryNum6er LastSdigitso(Buyer2/SpouseDriver's Srnte Last50igitsoJSocialSecunty
Lirense/lD/OrherNum6er Num6er License/lD/O[herNum6er