Homestead_Coomer (10)�
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INDIANA
P�eporer o(the Svla Disdosure Form
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Address (Numbe� vnd Street)
pi?� ce� I•t7 �17670
City,Smre, andZlPCode
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Seller I - Nameas5ppearson ronveyuncedocumen[
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Address (Number ond Stree[)
_ ,��;,• r_e.��,'n) �/7670
City, Smre, and ZlP lode
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Title
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Seller 2- Nome as oppears on
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Ad recs(Numberand5treetJ
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pC,iry, mte.andZ(lP�Code
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Under penalties of perjury, t hereby certify tha[ this Sales Disclosure, to the best of my knowledge and belief,�is true, corred
and��e as r qu' ed y law, and is prepared in accordance wAth I�C 6-1.�1-5. ,"Real Property Sales Disclosure Act".
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' Sign tureo(Seller �S�nom�eofSeler
�; S ��/e� s�la�'« i�k�l: �o �5 L�,�: S���S- "/2 -8 � � s
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Buyer I- Name as appears om m�veyvnce
Address(h'umberand5tree[) �-
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TNE SALES DISCLOSURE FORM MAY BE I15ED TO APPLY FOR CERTAIY DEUUCf10N5 FOR THIS PROPERTY. IDENTIFY ALL OF TNOSE THAT APPLY.
� 1. Will [his property be the buyer's primary
residence? Provide complete address of F
residence, induding county:
Address (Num6er and Svee[J
Ciry, Smre7JPCode County
�� 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated,
induding county:
Addrar (Nvmber ond Sveet)
City, Smle7lPCode
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3 Homestead J (nCJ �
4. Solar Energy Heating/Cooling System
5. Wind Power Device �
6. Hydroelectric Power Device
7. Geothermal Energy Heating/�
8. Is [his property a residen[ial
9. Would you like to receive fax
property via e-mail? (Provide
Not availa6le in all counties.) ��
- �`i-3� -.200 -ooY.
g Device
proper[y?
nents for this
�t information
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Under penalties of perjury, l hereby certify that this Sales Disclosure, [o [he best of my knowledge and belieP, is true, correct
and comple[e as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Proper[y Sales Disclosure Ac[". (Note:
Spouse informa[ion, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
b 'ngfiled.)
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Signomre o(Buyer7 Slgnamre o(Buyer2/Spouse
�"�es �/. Coo,�-e�' ia-�'� �
NumberLicense/ID/O[herNumtier. �.
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