Homestead_Burst INDIANA SALES DISCLOSURE FORM SDF ID: Paget
U P.REPARER ,
111 adiat I bk fYgtnt-
Preyarer of the Sales Disclosure Form Title
511b Corsa *1ve STE (Pt Tlrotas
Aqdress 14&AiAV-• V`t\ac, ' cn 'I', b2 Company 106 - b4Fel
City,State,and ZIP Code Telephone Number E-mail
E.SELER(S]/GRANTOR(S]
Darre ,/ X. Beirsf T'a has T_ 3itr61
Seller I-Name as appears on conveyance document Seller?-Name as appears on conveyance document
110 5; Ce.-Lfe✓• 73/ G7, fie /ay vr
I Address(Number and Street) Address(Number and Street)
/Jr/ncCtcn 6/76 7 a 1),I € Se, , ,7✓ 9-2 ,7O
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct
and co plete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Proper Sales Disclosure Act".
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Signature of Seller Syr anweeofSeller �r
on-en &E/ 7 - 28-/5 t. e a G _ �,_ �e 2i
Printed Name ofSeller Sign Date(MM/DD/m'YI Printed Name of Seller ( `c n Date(HM/DD
r.$UYER(S) .G_$AN�EE APPLICA 'PORs,PROPERTYi:TAX:'DEDUCTIONS-I'DENTIPYA - TYI .HA
e ? , ' r
erl-Name�asaappearsonn conveyance doe/ ent Buyer 2-Name as appears an conveyayjtJ cugery 2015
• !7S l flea /i V❑ 1 Y L J
Address(Numbel and Street) - Address(Number and Street)
elllnle/ , 4t76'?0
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES
❑ 1.Will this property be the buyer's primary la ❑ 3.Homestead
residence? Provide complete address of primary • E 4. o ar Energy Heating/Cooling System
residence,including county:
. 75/ . per41 r ❑ S.Wind Power Device
-t Address(Number and�S(reet) r ❑ [5- 6. Hydroelectric Power Device
- {Yrr bee, n Z'✓ °/7670 bd 4t'r! ❑ ff' 7.Geothermal Energy Heating/Cooling Device
' City,State ZIP Code County
❑ E 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 ❑ 3 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
includingcounty: below. Please see instructions for more information.
131 w. ?Dear VC Not available in all counties.)
Address(Number and Street)
erincemn I I� 41(710 &llbse 0240 -//- /.3 - ;_0,3 -ooy.57/ -o ,27
City,State ZIP Cade County
Primary prapertyowner contact name E-mail