Homestead_Poskin,[NDIANA SALES DISCLOSURE FORM17 SDF ID:
Di[jREPARER �: `��" ,— _' �
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Preperero([heSafes isddsureFw�n �
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�s (A'vmber and StreeQ
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Cin, Sm:e, and ZIP Code
1- Name as oppears m
i
Address(Numbe.and5:ree:) • ��� � L
A�t4i�BUR� hI; lI S lM' v
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Under penalties of perjur��, I hemby certify [hat this Sales Disdosure, to the b05t Of m}' kn0��'�fdg2 8nd bC�iOf, iS trllf, COf�2Ct
and cdfnoleCe as requirQd b}' law,�d is p�epared in accordance with IL 6-1.1-S.Sa"ReaiP�operty S�es D" closure AcY'.
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u��er I- i' me os cppears on cor,vry�aqce�O ume
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Addras(Nu. be�and5treet ��
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THE SdIES DISCLOSURE FORA7 AIAY BH OSED TO APPL�" FOR CERTAIN �E�URIOAS FOR TNIS
1 N''ll this ro erty be the buyer's primary
THAT
9uVer? � A'ame vs appeen an convwance dommen[
ndCress (A'umber and S.reet)
Cig. S:ot4 ond ZIFCode
� 3. Homestead
THATAPPLY.
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a ❑ � P P �
� residence? Provide complete address of primar 'L' ergy Hea[in�/Cooling Syscem
� re d nce, iqdudin� cou � S. N'ind Po�ver Device
w� �� �` � � �-'� � � � (] 6. Hydroelec�ric Po�ver Device
�, ers(Y.vmbercndS:ree�) /I�I_,/-�� �� �,1�\�
U"���l�v � ��y �(�-�� `-� "'�L �-��iJ� � � 7.GeothermalEnergyHeating/CoolingDevice
Ciry,S:eteZlPCode � Counry �
8. Is this property a residential ren[al propem�.
�� 2. Does the buyer have a homes[ead in Indiana to be
vacated for this residence? If yes, provide ❑ 9. Would you like to recei<<e tax s[atemencs for this
properq� via e-mail? (Provide contoc�in�orma[ion
complete address of residence being ��aca[ed, be(ow. Pleose see insrructions�or more in�ormotion.
induding county: Npt availa6le in all counties.)
Addrus(Numbe�and5:ree:) �/ �/�� �/ _ �Q� GDD.a�3� OpZ-/
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CintSmteZlPCode Cour.9' PrinarvproPery. mvnerronmanan.e c'mvil
Under penalties of perjurg, 1 hereby certi(y tha[ this Sales Disdosure, to the 6est of my kno�tiledge and belief, is [rue, correc[
and comple[e as required by taw, and is prepared in accordance wi[h IC 6-1.1-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/O[her numbers are not necessary if no Homestead Deduction is
beingfiled./�,L�KfL«'D�'� /lTy'w" l��%S//�'ZOI)
�na.^r.eo/B' r] ��I�q/ % O Slanamreo(Bvver?/Spouse
�ichqrd Denn�f ��sk�h � r
Las[ S diaiCS of Buyer i Drive: "s Sm[e Las[ S DigiCS af Socml Secun[}• Number
Lirense/ID/O[her Num,Ser
Pnn:ed Legal Name o( Buyer 2/Spovse
Sign Dare �MU/0o/rvvr7
LesiSdigicso(Bw=r?/Spous^Driver's Sm.e LasrSDigise(SanalS°cun9'
A'um6er Lirense/ID/Otnerh'umber