Homestead_Holmes (2)P5�
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INDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
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Bryceann Cutsinger
PreparmoJthe Salts Distlasurc Form iitfe
226 W. Broadway Broadway Title, Inc.
Addrm(NumberandSVetQ Company
Princeton, IN 47670 samantha.bti@mw.rivcbc.com
Ciry, State, ond ZIP Code Telephone Numbe� E-mail
:E�^SE�IER S GRAN7'OR S 3A- ���i�P+a.�a�� �g^� r4 fi K-aet� e�^3.—,.-"'� �i`-�� .�`ix_ F--•—c- ---*-.--�
t':far_. r _.ti_`xi-�.i�._'•_�.dF�'._>�'S�'Y.1�.4.i��_r s�'�_. u �^2..�_�.i_
Yong Rong Dong
Seller 1- Name as apyears on ronvryonre da'ument Seller 2- Name or appears on ronvrynnce document
1801 Brumfield Ave
Addres (h'umber ond Suttl) Addrecs (Numbe� and Stree[)
Princeton, IN 47670
Ciry, Smte, and ZIP Cade [iry, Sma, and ZIP Code
E-mail Rlt honeA'umber E-mall
Under penalties of perjury, I hereby certify [ha[ [his Sales Disclosure, [o [he bes[ of my knowledge and belief, is true, torrect
an comple[e as required by latv, and is prepared in accordance wi[h IC 6•1.1•5.5, "Real Proper[y Sales Disdosure Ac[".
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Si mreofSell<r Slgna[ureo(Shcer
Yong Rong Dong
Pnnttdh'vmeo Seller SipnDate M.4 D PnnledNameo Seller Si nDam MM 00
�F�:BUYERS',GRANTEES =_'APPL•ICATIONiFOR=PROPERTY;TAX�DEDUC-TIONS=°IDENTIFY'ALG•ITEMS.THATAP,FCY,� `�
Douglas Holmes
Buyer 1- Name as appenrs om m�veyantt document Buyer 1� Name os appears an ronveyanre dxumen
273 Souih 4th St.
Addros (Number and S(reeQ Addreu (M1'umber ond StreeQ
Princeton, IN 47670 ,/
E-mail Tele honrA'umber $ E�mail
THESALFSDISCLOSUREFORMMAY9EUSEDTOAPPLYFORCERTAIYDEDURIONSFORTHISPROPER7Y.IDENTIiYALLOFTHOSETNATA 1 r�.0
YFS KO CO\DITION I YFS NO COYOITIOY �TY
Q✓ ❑ 1.4Vi11 this property be the buyer's primary 0✓ ❑ 3. Homestead �TpR
residence? Provide complete address of primary � � 4. Solar Energy Heating/Cooling System
residence, including county: � 0 5. Wind Po�ver Device
1801 Brumfield Ave
Addreu(h'umbrrand5vret) ❑ ❑✓ 6. Hydroelectric Po�ver Device
Princeton,IN 47670 Gibson o 0 7.GeothermalEnergy Hea[ing/Cooling Device
Ciry. Sm:e ZIP Code Caunry
❑ ❑ 2. Does [hc buyer have a homestead in Indiana ro be � 0 8. Is this properry a residential rental property?
vacated for this residence? If yes, provide ❑ � 9. Would you like to receive [ax statements For this
complete address of residence being vacated, property via e-mail? (Provide contact in%rmation
including county: below. Please see instruc[ions for more information.
Not availa6le in all counties.)
Addrets(KUmberandSveeQ /f a ����� ���
Ciry.SmttZIPCode ^ '///�'/ �—
Counry
Pnmary propesry awner ran[oc[ name E�mall
Under penalties of perjury, I hereby certify that [his Sales Disclosure, [o [he bes[ of my knowledge and belief, is [rue, correct
and complete as required by law, and is prepared in accordance with IC 6-1.1•5.5, "Real Property Sales Disclosure AcY'. (Note:
Spouse infortnation, Social Security and Driver's License/O[her numbers are no[ necessary if no Homestead Deduc[ion is
beingf led.)
�I,Jn.-.��-�
SignamrrofBuyerl � Signamreo%BUy<rd/Spouse
Douglas Holmes
Social5ecuntyNum6er ' LostSdigiaofBUyer2/SpouseDriver's Sm[e Las[SDigiCto�SorialSecunty
Lirente/ID/O[herNumber Num6er License/lD/OtherNum6er