HomeMy WebLinkAboutHomestead_Lewis (3) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER - -
Bryceann Cutsincier
Preparer of the Sales Disclosure Form Title
226 W. Broadway St. Broadway Title. Inc.
Address(Number and Street) Company
Princeton. IN 47670 812-386-1687 samantha.bti(Wmw.twcbc.dom
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S) - ' -
Monte J Wirey Jo Ann Wirey
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
605 W Church St 605 W Church St
Address(Number and Street) Address(Number and Street)
Haubstadt IN 47639 Haubstadt IN 47639
Under penalties of perjury, 1 hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and ycomplete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller d Sign Nre of Seller \1
Monte J Name 3- �D 16 Jo Ann Wirey "ll` l4?
Printed Name o(Seller Sign Date(MM/DD(YYYt7 Printed Name of Seller {3((�Sig of ill?
F.[WYE: GRANTEE S -APPLICATION FOR PROPERTY TAX DEDUCTIONS=.IDENTIFY ALL ITEMS AT I
Charles R.Lewis Kimberly A. Lewis MAR @
I
•uyer I- ame as appears on conveyance document Buyer 2-Name as appears on conveyance document 1O iU
1004 S.Center St. 1004 S. Center St.
Address(Number and Street) Address(Number and Street)
Ft. Branch, IN 47648 Ft. Branch, IN 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 I YES NO CONDITION
szi ❑ 1.Will this property be the buyer's primary _�❑ 3.Homestead
residence? Provide complete address of primary ❑ Lir 4,Solar Energy Heating/Cooling System
residence,including county:
605 W Church SL ❑ 0 5.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Haubstadt, IN 47639 ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
0 ❑ 2.Does the buyer have a homestead in Indiana to be ❑ 0 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ Z 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.
1004 S. Center St. Not available in all counties.)
Address(Number and Street)
Ft. Branch, IN 47648 426. - l8 - 3(0 - yo ?-- 000 . a67- Oo9
City,State ZIP Code County
Primary property owner contact name Email