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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER
Bryceann Cutsinoer
Preparer of the Sales Disclosure Form Title
226 W. Broadway Broadway Title, Inc.
Address(Number and Street) Company
Princeton, IN 47670 812-386-1687 samantha.bti(@mw.twcbc.com
Ciry,State.and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S) - - - -
Jeremy R Brown
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
370E 780 S •
Address(Number and Street) Address(Number and Street)
Ft Branch IN 47648
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is tine,correct
and omplete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Si azure of er Signature of Seller
JeremyR Brown off /(4aol(0
Printed Name of Seller Sian Date(MM/DU/YY1Y) Printed Name ofSeller n I. •M/UD/YYY1)
F.BBUYER(S1/GRANTEE S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL IT ,TkAJAPP ,If
( Jonathan R. Blankenberger Paine Blankenberger
• document Buyer 2.Name as appears on conveyance docv)p&R 1 4 2016
500 S.Center St. 500 S.Center St. HHrr
Address(Number and Street) Address(Number and Street) n l�
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION —F6H81LQN
❑ ❑ 1.Will this property be the buyer's primary ` Z ❑ 3.Homestead
residence? Provide complete address of primary ❑ j 4.Solar Energy Heating/Cooling System
residence,including county: ❑ WI
370E 780 S 5.Wind Power Device
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Ft.Branch, IN 47648 Gibson ❑ Z 7.Geothermal Energy Heating/Cooling Device
City,StaP Code County
❑ 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 ❑ 2 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: bell •• • • •ens or more information.
Not available in all counties.)
Address(Number and Street)
024. -11-f9-.D Y-O0 (. d 8a -o.b
City,State ZIPCode Coon
•.. . .... .. ... ... . ....• E-mail