Homestead_Hartig INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D EREP,ARER- ----n--_ _—,-- ---- — -- - -- 1---
DANIEL A.MOON ATTORNEY
Preparer of the Sales Disclosure Form Title -
116 S.MAIN ST- REEVES,COCHREN&MOON
Address(Number and Street) Company
PRINCETON,IN 47670 812/385-8641
City,State,and ZIP Code Telephone Number E-mail
LE:,SEL'LER(S)/GRANT,OR'(Sjr _ — .7—',7,—,— ;r - :2.---.;,- a , „ .,.-- ar 77- . 7-,:-.]
COUNTRY AYRF INC
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
2282 F WARRFNTON RD
Address(Number and Street) Address(Number and Street)
HAUBSTADT IN 47639
Under enaltie apes -fr t ereby ce ' that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and c pll s re I, law,a ' repared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
/ ' ?
tore of Seller .' Signature of Seller
o d f .r't c.- /62-015—
Printed Name of Seller Sign Date(MM/DD/Wit) Printed Name of Seller Sign Date(MM/DD/YYrY)
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOS T P
YES NO CONDFnON YES NO CONDITION
❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead APR 6 2016
residence? Provide complete address of primary ❑ Ti 4.Solar Energy HeatinR(Cooling System
residence,including county: ❑ 0
S.Wind Power Devic 7AK�JtC4t.C7S�
Address(Number and Street) ❑ GI 6.HydroelectiglI3gW1101MTY AUDITOR
City State Z/PCade County ❑ 0 7.Geothermal Energy Heating/Cooling Device
IN
NI ❑ 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ is 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.
102 N.WALTERSST. Not available in all counties.)
Address(Number and Street) //�� y�
HAUBSTADT, IN 47639 GIBSON t9(0-93 -'UO-Qco - DD(/ gig-c�/�
ci
City,Sta te ZIP Code County
Primary property owner contact name E-mail