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HomeMy WebLinkAboutHomestead_Miskell (18) INDIANA SALES DISCLOSURE FORM SDF ID: - Page 2 :D PREPARER - , - - Kellee L. Rollins - Closing Agent Preparer of the Sates Disclosure Form • Tide 202 S. Michigan Street. Ste.300 Meridian Title Corporation Address(Number and Street) Company• South Bend. IN 46601 800-777-1574 mtc(Wmeridiantitle.com City,State,and ZIP Code Telephone Number E-mail :.E:SELLER(S)/GRANTOR(S)' - IF - I 'r I✓- ._ --e -- -."r: Seller l'Nome as appears an conveyance document - Seller 2.Name as appears on conveyance document • 301 W Ray Street Address(Number and Street) Address(Number and Street) Jacksonville IN 32202 .Under penalties of perju ,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct a lete as equirkdby a and 'sprepa`e�dd in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". Signature ofSe/lleer )` JY.,/\ J1 �fJ�n 11 Signature of Seller Andrew R Drake Attorney 4/6/16 V Printed Name o/Seller Sian Date(M.4/DD/YI'Yl) Printed Name of Seller Sign Date NH.M/DD/YYYY) F.-BUYER(S)/GRANTEE(S)-APPLICATION-FOR-PROPERTY-TAX-DEDUCTIONS=IDENTIFY.ALL.ITEMS.THATAPPLY,:_:,,- _ . .. Jason A.Miskell y� Buyer l-N e p an conveyance document Buyer2-Name as appears on convey ocysnee 5;2 Li M 1✓vRf'-/ 5 ddr Number and Street) Address(Number and Street) 1MCEf it3 w CfX70 )