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Homestead_Sartore INDIANA SALES DISCLOSURE FORM SDI:ID SDO ID 1810299 Page 2 D.PREPARER Bryceann Cutsinder P,roarerof the Sales Duclusure Form Title 226W.Broadway Broadway Title.Inc. Address(Number and Story Compary Princeton.IN 47670- 812-386-1687 samantha.bti @mw.twcbc.com Ciy.Stare,and ZIP Code Telephone Number E-mail E.SELLER(S)/GRANTOR(S) 1 Secretary of Housino and Urban Development Seller I•" m appears on conveyance dp-amens .Seller2-Nome as appears nn conveyance document AtlantaeaHomeOwnerhip Center 40 _Naiad-r=tta—S-I- Address(Number and,Street) Address(,Number and.Street) • Dry,State,and ZIP Code CID:S:rtc.and ZIP Code Atlanta, GA 30303 Telephone Number E-mail Telephone Number E-mail Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct lc plete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act"- njSell., P�I b__7"31',: 0IS Signature of Seller I F.BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS- IDENTIFY ALL ITEMS THAT APPLY David R.Sanore Royer 1-Pilaw a,npprrr-1 nn conveyance thrum rn: Dwyer 2-Name m appears oil conveynnte document 3629 N. 100 E. Address(Number and Srreet) Addr eas(::umber and Street) Patoka,IN 47666- YES NO CONDITION YES NO CONDITION © ❑ I.Will this property be the buyer's primary © ❑ 3. Homestead AUG 3 2015 residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: ❑ 205 E.SPRING ST. 5.Wind Power D Address(Number and Street) ❑ © 6.Hyd roelutis verCRWIN AUDITOR Patoka,IN 47666 GIBSON ❑ in 7.Geothermal Energy Heating/Cooling Device City.State ZIPCode County © ❑ ?.Does the buyer have a homestead in Indiana to be ❑ © B.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: below.Please see instructions for more information. 3629 N. 100 E. Not available in all counties.) Address,(Number and Street) aC (9 Lf a 4- 300 -DOO ysa-ue Patoka,IN e7666 GIBSON City.State ZIP care County Primacy property mvncr contort name E-mail