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Homestead_Miller (3)
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 ID PREPARER_1:14r T.,- : N St r —6—:----2..--71--- `. ,, .r-..t7- ' — - _. . . _. . --: —___ Roman Ricker Attorney Prepares of the Sales Disclosure Form Tide P.O. Box 13,219 N. Hart St. Hall, Partenheimer&Kinkle Address(Number and Street) Company Princeton, IN 47670 812-386-0050 rrickeranhpk-law.com City,State,and ZIP Code Telephone Number E-mail rE:,SELITIM)1/GRANTOR(S)t. i `, lr i >,> v,. -t :- r .-- r ° rt_'_b_1T�.� Dan J Anderson Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 620 S Old Patoka Road Address(Number and Street) Address(Number and Street) U- i e •enalties o r 'ury hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct And corn'lete t equired r law,and is p epared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". at.�1 .s.,. , _ ,_,_ WISP!!of Sell Signature of Seller Pa r e r.- `.:1*'i Date IMM2016 Printed Name ofseller Sian Dale(MM/DD/YYY11 Printed Name of Seller Sian Date(MM/DD/YYYY) 4';BU,YER(S),GRANTE(S)7=dPRLIGATIOSf iak+,PROPERTYrTAX•DEDUCTIONS dENTIFYALL•ITEMS;THAT_APPLY -_ f '`__ Mitchell L. Miller Cynthia J. Miller Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document 2007 Chamblee Drive 2007 Chamblee Drive Address(Number and Street) Address(Number and Street) G� 9G Valparaiso, IN 46383 Valparaiso, IN 46383 9. G' w• �_- ''" THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. LT` i YES NO CONDITION YES NO CONDITION •YC• E ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead �,j0 residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling Syst€m residence,including county: 620 S Old Patoka Road ❑ fJ 5.Wind Power Device Address(Number and Street) ❑ Q 6. Hydroelectric Power Device Patoka, IN 47666 Gibson ❑ g 7.Geothermal Energy Heating/Cooling Device City,State ZIP Cade County ❑ ❑ 2. Does the buyer have a homestead in Indiana to be ❑ $ Is this property a residential rental property? vacated for this residence? If yes,provide ❑ 171 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. qqqqqq Not av�ail�a le in all counties.) Address(Number and Street) c,,(6 -o rs, 7"O- QO O. / OHO 'Mitchell&Cynthia Miller City,State ZIP Code County Primary property owner contact name E-mail