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INDIANA SALES DISCLOSURE FORM SD ID: Pa•e 2
Candace Black reo processor
Preparer of the Sales Dlsclasere Form Tide
3962 Red Bank Road - Soioumers Title
Address(Number and Street) • Company
Cincinnati, OH 45227 - 513-333-7251 candace.blackesoiotitle.com
City,State,and ZIP Cade Telephone Number E-mail
CSELLERjSJ"JGRhETOR7 1-, —' x k o- _— -= -3" _ �r_,:
•
Fannie Mae ANA Federal National MortgageAssnriation
Seller I-Name as appears on conveyance doament Seller 2-Name as appears on conveyancedacunrm[
P C) Box 650043
Address(Number and Street) Addrm(Number and Strut)
Dallas TX 75265-0043
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief.Is true,correct
and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,'Real Property Sales Disclosure Act'.
Signaure of-Seller Signature of Seller
Proved NRRa(me of Seller m Sian Date(NM/Vt/nm Printed Name o/Seller S AD Ii?,B$ N/D.Pa T)
-F.BUYE 5J RANTEEIJI-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALLI •hI AI�t'Jt _
I .
,� cane ar appears on conveyance dacumeat Buyer 2-Name as appears on conveyance doe 1 2016
- 12422 East 100 South JUIY 2016
Address(Number and Street) Address(Number and Street)
Oakland City,IN 47660
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
0 ❑ L Will this property be the buyer's primary ( ❑ 3.Ha a
residence? Provide complete address of primary u QJ 4.-Solar Energy Heating/Cooling System
residence,including county: ❑ ® 5.Wind Power Device •
12422 Fast 100 South 7'�
Address(Number(Number and Street) ❑ IA 6.Hydroelectric Power Device
Oakland City. IN 47660 ❑ ® 7.Geothermal Energy.Heating/Cooling Device -
City,State Z/ Code County
❑ 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 ❑ ® 9.Would you like to receive tax statements for this
I complete address of residence being vacated, property via e-mail?(Provide contact information
including county: below.Please see instructions for more information.
Not available in all counties.)
Address(Number and Street) / I,
City,Score 9P Code County �/ /`."/8 - 20c/- `Oo . 360 -co 6
Primary property owner contact name E-mail