Homestead_Seramur INDIANA SALES DISCLOSURE FORM SDF ID: Page Z
D.PREPARER
Amber Messmer Closer
Preparer of the Sales Disclosure Form Title
606 Main St. Dubois County Title Co., Inc.
Address(Number and Street) Company
Jasper. IN 47546 812-482-1696
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S)
Brenda .lane Hovis
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
)aa S _ Luc/etca Si -
Ad (Number ands t) Address(Number and Street)
CLL(a+- C( h (Al g7fo60
?nj .
Under penalties of perjury, 1 hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete as re iredd (byyllaw,and is prepared in accordance with IC 6-1.1.5.5,"Real Property Sales Disclosure Act".
4V/17/It Wilt/kV
i
Signature of Seller Signature of Seller
Brenda.lane Hovis 8-6-15
Printed Name of Seller Sian Date(MM/DD/YYYY) Printed Name of Seller i 1 ' i t S; e(MM/DD/YYYY)
F.BUYEf1/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS- IDENTIFY ALL I j S ( H4 T Asa, �\
James J. Seramur& Faye L. Sera •
.uv once document Buyer 2-Name as appears on conveyance dtAIit 1 4 2015
02,2a S- Lucre a -
A9?ress(Number ndS t Address(Number and Street)
r (NJ 470600 armiischt_.---
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
-YES NO CONDITION N
[N" ❑ 1.Will this property be the buyer's primary < wi. ❑ 3. Homestead
residence? Provide complete address of primary treating/Cooling System
, residence,including county:
�'M Pt•t• {t,y/ ❑ [� 5.Wind Power Device•Address(Number and Street) �Li V�n El 2' 6. Hydroelectric Power Device
1
f% t7 ll,
i•J i�. ❑ ge 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code `' Co.my ❑
❑ [vJ 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 ❑ 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.
it : •1 ,, • , Coun le .
Address(Number and Street)
2 —iy—/P- 303 - 000. 'b o A -007
City,State ZIP Code Caunfy
Flinty owner contact name ail