Homestead_Block INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
I D.RREPARER"y{ ,- .',t _-' -_4.--7 I. I:-.C 'E `!—•'- '• -- _ - -" ;•. - •__` -- - . --
L. Edward Cummings Attorney at Law
Preparer of the Sales Disclosure Form Title
513 Main Street Hart Bell. LLC
Address(Number and Street) Company
Vincennes, Indiana 47591
E-mall
{E.SEEllER(S)%GRANTOR(S)(,r J_.r... f i— r-7.1.2_7.--;„`._ ._'7,,:„..,--7,i;_: _ ?_e .- , • I:'.
Edward Henry Block Revocable Trust dated December 2R 2004 Edward Henry Block& DeAnna Rene Block Trustees
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
3234 E 525 S - Same
Address(Number and Street) Address(Number and Street)
Princeton Indiana 47670
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complet s required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
- w • • 7-7-e g /P.t(�ni, Pte, 734,47_ --i EE
Signature ofSeller Signature of Seller
Fdward Henry Rork Trustee DeAnna Rene Block Trustee
Printed Name of Seller Sian Date(MM/DO/Y1111 Printed Name of Seller Sign Date(MM/DD/YYYI]
(F'BUYER S)'/,GRANTEE(S)_:;APP(CATION',F,ORPROPERTY+TAX<DEDUGTIONS�IDENTIFY:ALL' Iv , AT1pP.AL - '' `. _
Brian E. Block Natalie J. Block 0 1 IA!"'f1
., .,,• • .,pears on conveyance document Buyer 2-Name asappears on conveyance document
3770 East 550 South - Same JAN 2 7 2016
Address(Number and Street) Address(Number and Street)
Ft. Branch, Indiana 47648 ,/)
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
igi ❑ 1.Will this property be the buyer's primary Fl Li 3.Homestead
residence? Provide complete address of primary ❑ [LU 4.Solar Energy Heating/Cooling System
residence,including county: ❑
3770E 550 S 5.Wind Power Device
Address(Number and Street) ❑ igi 6.Hydroelectric Power Device
Ft. Branch, Indiana 47648 Gibson ❑ Fl 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
El Fl 2. Does the buyer have a homestead in Indiana to be El IS 8. Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ Fl 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
including county: below. Please see instructions for more information.
Not available in all counties.)
Address(Number and Street)
44(1.04 _ Sao - ooh . tjoS- -v .L S
City,State ZIP Code County
Primary property owner contact name Email