Homestead_Smith (17)INDIANA SALES DISCLOSURE FORM1t SDF ID: `M � Page 2
1' �
Preparer o(the Sales Disclasure Form
�irecs (Num6er and StreetJ
Ciry.Sm[e. ondZlPCode
Seller]-Aameosop eartonconve anredocumm[
l.� ��t;+a �
Addr 6etand�S[�r ,e,f,J��
� � ��� � �7� � �
G [ andZIPC e
� "��-��
,
Tele hone Nvmber E-mail
Under penalties of perjury, 1 hereby certify [hat this Sales Disdo
Xand�� et�reqyire��w, and is prepared in accordancl
1 (� �
Buyer
and5treecJ
Title
lompany
Telephone Number
�euer t-wome as appeors on'rom�eyanre document
S[�AM �i
Addres (Number und StreetJ
£-mvil
E-moil
to the best o( my knowledge and belief, is tne, correc[
IC 6-1.Pr5.5� �eal�Property Sales Disclosure AcY'.
Buyer7 - Name os appears on com�eyance dorument
Address (A'vm6er and SneeQ
Qry', Sm¢, andZlPCode
THE SALFS DISCLOSORE FORM MAY BE OSED TO APPLY FOR CERTAIA OEDUCf10NS FOR THIS PROPERTY.
� ❑ 1. Will this property be the buyer's primary
residence? Provide complete address of prima �
r sidence, induding county:
�� t 2 f'>'1 !lc �,-�
Address(Numbernnd5[reetJ ,
�� ux�n.e-v..(.l.e_ � nj U7 4 G S �,�
Gry. Srnte ZIP Code Counry
❑ �] 2. Does the buyer have a homestead to be vacated for
this residence? Ifyes, provide comple[e address of
residence vacating, including county:
Address (Num6er and
�❑
■ 7
� �
■ !7
■ C�
�e�nerwi --IOSETHATAPPLY.
CONOITION
3. Homes[ead
gy Heating/Cooling Sys[em
5. Wind Power Device
6. Hydroelectric Power Device
7. Geo[hermal Energy Heating/Cooling Device
8. Is [his property a residential ren[al property?
a��-/�%� �dO=G���/� 4�
Under penalties of perjury, 1 hereby cer[ify tha[ this Sales Disclosure, to the best of my knowledge and belief, is [rue, correct
and comple[e a jrequired by law, and is preQared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Ac[".
Signam�e of Buytr2
/�