Homestead_Ross (2) P i
INDIANA SALES DISCLOSURE FORM SDI:ID SDO ID 1820601 Page 2
11:7',PREPARER 4.-:'-':',:iTLT4CF:.,,;7.: 4.4-rj?)4‘'-77it:‘,.,-,. .'.-- : ..)::.,-,:',..:j 4,77-Z•,,"*.i..r:T.- , S-'::'--,?, .14TifiCt ,I".'4'?"'"' ''' t!:-4, .? ."-.., -, .-: - •
CARLA WALTMAN ESCROW CLOSER
Preparer of Mr Sales Disclosure Form Title
331 FRANKLIN ST TITLE CENTER OF INDIANA
Addrers(Number and Street) Company
COLUMBUS,IN 47201- 812-372-1170 OTITLECENTEROFINDIANA.COM
Po..State,and ZIP Code Telephone Number &mod
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E.SELLER(S)/GRANTOR(SY---;:.x•.--Wt k;("!:-:,-..?,trY,',1.-zr47t:_::'-.:i -.7t,\11:-..-->::....:prir.;.::::YilA4=:•:.:ic- .-c:F--1;- *,;`,.,' .-. ...• 71-7,.,
COUNTRY AYRE,INC.
Seller I.Name as appears an conveyance document Seller 2-Name as appears On connyonce document
2822 WARRENTON RD
Address(Number and Street) Address(Number and Street)
Under p•nalties of p ry,I hereby c rtify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and ,, ete as re ed by I ,a s prepared in accordance with IC 6-1.1-5,5,"Real Property Sales Disclosure Act".
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Ann. ire of Seller Stgern Idle of Seller
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Mr.erf!Orme niCrlier Ono IleneDM inntywn . P■Ittm-10.21,•',Mow i
F.BUYFPf 51-/GRANTEE(S)=:APPLICATION:FOR PROPERTY.TAX•DEDUCTIONS-11DENTIFY.A C TE.1 I - V.
(-CONNIE L ROSS
buyer.-lame as appears on conveyance decument Buyer 2-Name as appears ass--5—A,PR-1 1 ZUlb
522 S 8TH AVE
Address(Number and Street) Address(Number-and Street)
HAUBSTADT,IN IN 47639-
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THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION
El 0 1.Will this property be the buyer's primary
residence? Provide complete address of primary El E 4.H te
Solar Heating/Cooling System
residence,including county:
522 S 8TH AVE 0 0 S.Wind Power Device
Address(Nurnher and Street) 0 0 6.Hydroelectric Power Device
HAUBSTADT,IN 47639 GIBSON 0 L..]CI
7.Geothermal Energy Heating/Cooling Device
City.State ZIP Code County
0 El
0 0 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 0 El 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: •.1 -..,. '' -. - - , . i. ; •-Hare information.
Nor available in all counties.)
adieu(Number on:Street)
3 -cgp-doo .000 . 8 1 cfr-oo ?
City.kale ZIP Ode . m CY
_ Prinumy property owner contact name E-mail
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