Homestead_Kohler (3)INDIANA SALES DI
Bryceann N. Cusinaer
Preporer o(the Saler Dlsd¢sure Form
_ 226 W. Broadwav
Addrm (Nvm6er and Strre:)
Princeton.IN 47670
Ciry.Sm(q and ZIP Code
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Seller 1- A'ome os appears an conveyonte da'vment
ioszl w sa i65
Addras (Nvniber and Streel)
Owensville IN 47E65
eiry, smre, ona zlr eode
Title
3roadwav Title. In
Company
l72-386-1687
Telephone Number
Seller7 � A'omo os oppeors on tanvqvnre davmen[
Ciry.SmtK andZlPCode
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Under penalties of perjury, 1 hereby cer[ify [ha[ this Sales Disclosure, to Ihe best of my knowledge and belief, is true, correc[
and comple[e as required by law, and is prepared in accordance with IC 64.1-S.S "R�e�al P'r/operty Sales Disclosure Ac[".
�ip���N-// j��u.,w�C.� ,�,�✓�c�lw �
Signamreo/Sel� � Signa[urea(Seller � � � �
Ruyer 2� Nmne as appeurs on ronvryonrr dotument
5746 5.960 W.
AdJrese (Numbrr and SnretJ AdJress (Number vndSt
Owensville.IN 47665
Ciry. SmtG mdZlPCode Ciry.Sta[r. anJZIPCWr
THE SdLES DISQOSURF. FORN !f AY BE USED TO APPLV FON CERTAIS DEUIlR10\'S FOR THIS PROPHRTI'. I DEKTIR' dLL OF THOSE THAT APPLI'.
Q ❑ l. N'ill this propercy be the buyer's primary
residence? Provide complete address of primary
residence, including county:
AJdrrss(Numb and5vre:)
O+.vensville IN 47665
Ciry:5mte2"Cadr Coung.
❑ � 2. Does the buyer have a homes[ead in Indiana [o be
vacated for[his residence? Ifyes, provide
mmplete address of residence being vacated,
including county:
Addmss (Number and SveetJ
)wensville, IN 47665
Gry, Smre ZIPCode
� ❑ 3. Homestead
�U �J 4-�lar'Ene�gyHea[ing/Cooling
❑ � S. 4Vind Power Device
❑ Q 6. Hydroelec[ric Po�ver Device
❑ � 7. Geothermal F:nergy Heating/C
❑ 0 8. Is this property a residen[ial r
❑ Q� 9. Would you like to receive tax �
property via e-mail? (Provide c
g Device
property?
nents for Ihis
�t information
re information.
� Not available in all coun[ies.) �
_ ��,�,4- tao-ooY•3 96-v�./
� I rnmarypmperryownerconmaname � t-mo�✓
Under penalties of perjury, 1 hereby cer[if}� that this Sales Disclosur—he e�f my Icnowl3g�-belie(, orrect
and comple[e as required by law, and is prepared in actordance with IC 6-1.1-5.5, "Real Proper[y Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/O[her numbers are not necessary if no Homestead Deduction is
being f,i/led.)
,/b�.C.u�z � . �-��iG�g.cJ
Signv[vre af Bvyerl Signomrc of9vyer2/Spovse �
Grace E Kohl=r � / — c�: —�5
Licente/ID/Other A'um6er
Pnnled Lepal Name oj Bvyer 2/Spouse
Da:e�11A1/DO/YYYI]
LastSdigi[sof8uyer2/SpouseDriver's Smte Las[SDEgitso/Sotiof5ecunry
Number License/ID/OtherNum6er I
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