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FORM SDFID:
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Addr¢s(Numberand treetJ
��./AriSJi�� IA; �7`I(1
Ciry, Smre. andLPCade
Sellu 1 - Name as
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Under
and ca
7itle
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lompany
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Seller 2- Nome as appears an convryanre dorumen[
Add�ess (Number und SaxtJ
Ciry, Smce, and ZIPCOde
1 hereby certify [ha[ this Sales Disclosure, to [he best of my knowledge and belief, is [rue, correct
y law, and is prepared in accordance with IC 6-1.1-S.S, "Real Property Sales Disclosure Act".
Signamre oJSe!!er
I
Buyer 2- Name as appears on ronveyanre document
ddd� (Number and Svee[)
' �� �� I Ciry,SmtGandZlPlode
THE SdLFS DISdOSURE FORM MAY BE IISED TO APPLY FOR CERTd1Y DEOUGTIONS FOR TNIS PROPER7Y. IDEN77FY N.L
i�ji Lf 1. Will [his property be [he buyer's primary
residence? Provide complere address of primary
I� I a c re�l� re iL. ncluding cp ��:
"J `[ J ..JIlA1L �
Addr� (NUmber and Sveetf
P��+,�n ��r. �-���v �-��Y�
CiN.SmreZIP[ade [aunry
� �2. Does [he buyer have a homestead in Indiana [o be
vacated for this residence? If yes, provide
comple[e address of residence being vaca[ed,
including county:
AdCr¢i (NUmbrr and Stree[J
Co4nN
3. Homestead
THAT,IPPLY.
n� Coolin� Sys[em
S. Wind Power Device
❑ � 6. Hydroelectric Power Device
❑ � 7. Geothermal Energy HeaUng/Cooling Device
� � 8. Is [his property a residential rental proper[y?
❑ � 9. Would you like to receive [ax s[atement5 for this
proper[y via e-mail? (Provide contact informatlon
below. Please see instructions for more information.
Not available in all counties.)
a �-� i-a o-aoo-000 ��.�-aa ✓
vrv �m.�em mvner ronmct nome E-mail
Under penal[ies of perjury, 1 hereby certify that this Sales Disclosure, to the best of my Imowledge and belief, is [rue, torred
and comple[e as required by law, and is prepared in accordance wi[h IC 64.1-5.5, "Real Proper[y Sales Disclosure Ac[". (Note:
Spouse information^Social Security and D�river's License/O[her numbers are not necessary if no Homestead Deduttion is
Sign
Sigmmre afBvya2/Spause
Pn'nredLegalNameofBUyer2/Spouse SlgnDare(MM/UO/YYY1j
LastSDigitsof5acia15ecuntyNum6er I Los[Sd(giaofBuver2/SpouseDnver's Smte LastSDigiGSafSocial5ecunty
License/ID/OtherNumber Num6er License%ID/OtherNumber