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Homestead_LeonbergerOrsdosvre Form 19 N. W, FOURTH ST.. STE 500 arys�u,a�F1VIkNS LE, IN 47708 Title Company � - _ . .. � ,: . . KEVIN E. EMMETT RRFNDA S EMMETT Seller 1- Name as oppears on ronveyonre document SeRer 2- Name as aypears an ronveyonre dorumen[ �3a3 G� ��S �S'ou�l, �i,1n� Add�(Numberand eetJ Addr�(NvmberandSVretJ �lvf'195U/ �E l�li �%(o(p� Ciry, Smtg E-mail Under penal[ies of perjury, 1 hereby certify [ha[ [his Sales Disclosure, to the best of my knowledge and belief, is true, correct and co plete a required by law, and is prepared in accordance with 6d.1-S.S, "Real Property Sales isclosure Act". �'�._ ..�� �- . I � .��,�,�.� �� ►ti , Q���S TNE SAIFS DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAI\ UEDURIOYS � U 1. Will this property be the buyer's primary residence? Provide complete address of � resi ence, i dudi county: �l(�)Q 1SUi�IP� "'/nI �-���5 a�hsc�n Ciry, S[�teT/P Code Counry ❑� }'� I 2. Does the buyer have a homes[ead in Indiana to be �T va[a[ed forthis residence? Ifyes, provide comple[e address of residence being vacated, induding county: Address (Num6er andSveetJ Ciry, Srare ZIPCade Comry ' PROPERTY'. IDEMIFY 3. Homestead ,/ 4 Solar Energy Heating/Cooling System � � 5. Wind Power Devire ❑ � 6. Hydroelectric Power Device ❑ `� 7. Geothermal Energy Heabng/Cooling Device � � 8. Is [his property a residential rental property? ❑ �9. Would you like [o receive tax sfatements for this properry via e-mail? (Provide rontoct informotion below. Please see instructions for more information. Not availa6le in all counties.) a� -��- Q� . ��o . � � ���- o�, Fnmvrv omcerro owner ronmct name E-maii Under penalties of perjury, 1 hereby certify that this Sales Disclosure, [o the best of my knowledge and belief, is [rue, correct and complete as required by law, and is prepared in accordance with IC 6-11-5.5, "Real Property Sales Disclosure Act". (Note: Spouse information, Social rity and Driver's License/Other numbe are not necessary if no Homes[ead Deduction is being filed�}-� .>� �� / � /J n�// /J I �/2 z/io �� � Las[Sdigi[so(Buyer7Driver's StaCe Las[SDigi[sof5ocia15ttuntyA'umber I Las[Sdigiuo%Buyer2/SpouseDriver's Smte LastSDigiaof5oria(Security Lirense/lD/OtherNumber Num6er Lirense/ID/O[herNumber