HomeMy WebLinkAboutHomestead_Kell (2)INDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
D.PREPARER _ . - .
Nancv Dallas Ducharme
Repvruo(rhe5afesUudosvreForm TNe
213 S. Main ST
Addrgs(A'umberand5treef) �ampany
Hazleton IN 47640
E-mvi!
' E. SELLER S GRANTOR S• • ° �
.leremy Dean Duchartna N�nr.v Dallas Ducharme
Se!ler 1- Name as appmrs on ronveynnce document Shcer2 - Name as appears on conveyance dacument
21't S Main ST 213 S. Main ST
Addras (Numberund StreetJ Add�as (Num6er and SVeetJ
Jjazleton. IN 47fi40 Ha�leton. IN 47fi40
lity, Smte, andTJPCode Ciry, Slare, and ZIPCade
E-mail Tele honeNum6er E-mail
Under penalties ofppp��� rjury, I hereby certify tha[ this Sales Disclosure, to [he best of my knowledge and belief, is true, correct
an omple as�red by law, and is prepared in accordance� /wJith IC 6- 1-5.5,' R%(I Property Sales Disclosure Act".
� il�nr�u�CJ(,�n M1L0
Sjgna reo(Seller � SignaN eof5eller t
Jeremv Dean Dur.harme �a/�a�aa�s Nancy Dallas Ducharme �Oi'[S�o�%'/�
PnntedHameo Seller SI nDatt x.uNO PrintedNameo Seller n .v D
:-F.�BUYER S GRANTEE S�-_APPLICATION FOR PROP.ERTY TAX DEDUCTIONS- IDENTIFY ALL ITE T A APP • �'
h n I A. R. K II Brandi Nicole Kell
' nveyvncedocumen[ Buyer2�Nameasappearsoncanveynnredocu��C 2 3 �2�015
1101 Virqil Blvd 1101 Virail Blvd
Address (A'umberand StreeQ Address (Number and Sveet) n'
Princeton IN 47670 Princeton.IN 47670 ./H..._�
Clry,Smre,andZlPlade
OF THOSE TNAT APPLY.
YFS KO CO\DRIOH I '
�✓ � 1. Will this proper[y be [he buyer's primary Q � 3. Homestead
residence? Provide comple[e address of prim , o ea[ing/Cooling System �
residence, including county: � �
213 South Main Street 5. Wind Power Device "
Addr�(NumbvandSo-eetJ ❑ ❑ 6. Hydroelectric Power Device
Hazleton.IN 47640 Gibson �
❑ ❑ 7. Geothermal Ener� Heating/Cooling Device
liry, Smre LPlode Counry
� �✓ 2. Does the buyer have a homestead in Indiana to be � ❑ 8� �s is property a residential rental proper[y?
vacated for this residence?� If yes, provide ❑ 9. ould you like to receive tax sWtements for [his
comple[e address of residence being vata[ed, ro erty via e-mail? (Provide conmct information
including county: 6elow. Please see inshvcdons for more informatlon.
C Not availa6le in all councies.)
Addras (A'umberand Street)
a�-o�- s9_o3z -000.osa_oip
City, Smle LPCode Counry
PAmarypropertyownermnmctname E-mail
Under penalties of perjury, I hereby certify that [his Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance with IC 6Q1-5.5, "Real Proper[y Sales Disclosure Act". (Note:
Spouse information, Social Secu ' and Driver's License/O[her numbers are no necessa if no Homes[ead Deductlon is
beingfil .) � �
!Z /1 zolS
igna reof uyerl � naNreo(Buyer2/Spouse � / Vq/" ^nJ ^/
IA R K�II Brand'N Krll ��'/ I II�IA J
Pn ed Legal Name ofBu}rer 1 Slgn Da[e (HM/uD/vrvn Printed Legal Name ofBuyrer 2/Spouse Sign Date (MN/�D/rrrh
License/ID/OtherNum6er Num6er License/!D/OtherNum6er