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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D$REPARER •p ; .r ----7,-111—.'77-777. ^ ,3 . C tT ——E C T T
Ray M. Drulev Attorney No.4759-26
Preparer of the Sales Disclosure Form Title
505 N. Church Street, PO Box 146 Law Office of Ray M. Drulev
Address(Number and Street) Company
Fort Branch, IN 47648 812-753-4975 drulevlaw(a)yahoo.com
City,State,and ZIP Cade Telephone Number E-mail
iSSEL'LER(S itareiNTOR(S)I Tir - — — .! ,-,.--r >- -z .?- --a:--T T-5
Lloyd Jones
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
722 Highland Ave
Address(Number and Street) Address(Number and Street)
Under penalties of perjury, 1 hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and •mplete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
mss✓, /11 -
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fSignatur/f -0e Signature of Seller
I lnyd Jones
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Nome o(Seller Sign Date(MM/DD/YYYY)
F,-BUXER(S]'/,GRANTEE(S)T APRLItATIONt FOR1PROP.ERTYETAXDED UGTI0N5<:IDENTIF,YALLrIT T PP
Jessica A. Montgomery _
Buyer l-Name as appears on conveyance document Buyer 2 Nome as appears on conveyan /
314 W.Trusler
Address(Numberand Street) Address(Number and Street) JUN 1 7�y
206
Fort Branch, IN 47648 _
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I YES NO CONDITION
is ❑ 1.Will this property be the buyer's primary 151 ❑ 3.Homestead C
residence? Provide complete address of primary ❑ ID 4.Solar Energy '-eating/ poling System
residence,including county: ❑ is
314 W Truster 5.Wind Power Devi
Address(Number and Street) ❑ Q 6.Hydroelectric Power Device
Oakland City,IN 47660 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑
cg 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 ❑ 0 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: below. Please see instructions for more information.
Not available in all counties.)
Address(Number and Street) y�
City,State ZIP Code County ;4—ILl_h _JDI -000'aia -001
Primary property owner contact name E-mail
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