Homestead_LottINDIANASALES DISCLOSUREFORM SDFID:
D.PREPARER
R'eparer o/[he5oln Disdosure Farn� TiUe
279 N. Hart Si.. PO Box 13 Hall. Partenheimer & Kinkle
Addr¢s (Xmrber and StratJ Componv
Princeton.IN 47670
Ciry, Smre. und Z/P lode
Selier 1- Name as opprors on convrym<e document
S65R W 675 S
Addrna (Numbr and 5[rce[)
Te/ephone Nnmber
Se/kr Z� A'orne os appears om m�veyonre doaument
dddreas (NUmberandSamtJ
Owensville IN 47665
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E-mail
Under penal[ies of perjury, I hereby certify tha[ this Sales Disdosure, [o [he best of my knowledge and belief, is true, correc[
and comple[e aue�/qu�ire�d� by/ �law{-,�jnd is prepared in accm'dance wi[h IC 6-11-5.5, "Real Property Sales Disclosure Act".
�C,PJ"�-�" G'l/cX_.lic,�C I �-e �.t �'��di 7:�.t,Fi�
Signowreo/Seller � SignamreofShcer
I Name
mnvevanreJx�ment
APP6Y.
[V� � 3. Homestead
�e a[ing/Cooling System
� Q 5. Wind Power Device
❑ Q 6. Hydroelect�ic Power Device
❑ Q✓ 7. Geothermal Energy Hea[ing/Cooling Decice
� �✓ 8. Is this property a residential ren[ai property?
❑ ❑✓ 9. lNould you like [o receive [ax statements for this
property via e-maiR (Provide contact information
6elo�v. Please see instructions for more information.
hbt availaGJe in all roun[ies.)
2 •
Under penal[ies of perjury, 1 hereby cer[ify that [his S21es Disclosure, [
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