HomeMy WebLinkAboutHomestead_Cooper (2) • INDIANA SALES DISCLOSURE FORM SOF ID: Paget
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fPREPARERy_- _
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Brian K.Mahoney Attorney
Preparer of the Sales Disclosure Form Title
822 Main Street,P.O. Box 176 Mahoney Law Office
Address(Number and Street) Company
Petersburg,IN 47567 812 354 8121 mahoneylawOnwcable.net
City,State,and ZIP Code Telephone Number
E-mail
E.SELLER($)/GRANTOR($) _` '=- 1_ - - - -
Estate of Mary Alice Clifton by David W Clifton PR
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
13144 Gore Rd
Address(Number and Street) 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
and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
/60.4. of
S"natured Seller f/
49 f v Signature of Seller
Fstate of Mary Alice Clifton by David W Clifton k- 1)' /5—
Printed Name of Seller Sion Date(MM/DD/YYYY) Printed Name of Seller Sian Date(MM/DO/rrn'1
5;BUYER(SVGRANTEE($).-.APPLICATION-EOR,PROPERTY_TAX DEDUCTIONS-IDENTIFY ALL•ITEMS THAT APPLY.' _ _-..
Deborah Cooper
Buyer)-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
710 S Walnut Street P ,/ >-
Address(Number and Street) Address(Number and Street) - A
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT AI%
CO
YES NO CONDITION I YES NO CONDITION
Q ❑ 1.Will this property be the buyer's primary [ E-7 3. Homestead t " 7). '
Aiti
residence? Provide complete address of primary ❑ is 4.Solar Energy Heating/Cooling System U/TO
residence, including county: ❑ 5.Wind Power Device R
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Pike ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
El Ill 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 ❑ 0 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) eN _^/ �y^
City,State ZIP Code County d (o- I +/9 _ / O2 _ coo . ) 1k,- ct l
Primary property owner contact name E-mail