Homestead_Anderson (2) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D:PREPARERL j -° _ nTsr ;i. ' Patti Kolb Closing Manager Preparer of the Sales Disclosure Form Title 226 W Broadway St Broadway Title. Inc. Address(Number and Street) Company Princeton, IN 47670 812-386-1687 Datti.bti(amw.twcbc.com City,State.and ZIP Code Telephone Number E-mail E:SELhER(S)%GRAN,TOR(S)T _ r e'r- i . - — • Angela K Mason Seller I-Name as appears an conveyance document Seller 2-Name as appears on conveyance document 184 F 200 S Address(Number and Street) Address(Number and Street) Princeton IN 47670 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". S L : Signature of S ler Signature of Seller Angela K Mason (C Printed Name of Seller Sian Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYY11 ;F:BUYER(S)/GRANTEE(S) APPEICATIONIEMDROPERTY_TAX.DEDUCTIONSf IDENTIFY.All ITEKOTHAT,APPLX Kimberly R.Anderson Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document 9742 E 450 S 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 PLY . ( YES NO CONDITION YES NO CONDITION L�M Q GIBBON COUNTY AUDITOR ❑ 1.Will this property ty be the buyer's primary ry Q 3. Homestead residence? Provide compiete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: 4742 F 450 S ❑ Fd 5.Wind Power Device Address(Number and Street) ❑ Q 6. Hydroelectric Power Device Oakland City,IN 47660 Gibson ❑ 171 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ Q 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 ❑ Q 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) City,State ZIP Code County G24 (3-3s . - �e o9co - Oo( Primary property owner contact name Email