Homestead_Breitweiser INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
Amber Messmer Closer
-
Preporer of the Sales Disclosure Form Title
606 Main Street The Title Co.
Address(Number and Street) Company
Jasper. IN 47546 812-482-1696
City,State,and ZIP Code Telephone Number E-mail
SELLER(SJ%GRANTOR(S) ' - - - - — -_-!..-1 ' ' . - __ ,_ --
Connie J.Casey
Seller] ame as Dean onconveyan- ocument Seller 2-Nome as appears on conveyance document
I I �t VMS .
AdAre•s(Number and S•reet) Address(Number and Street)
Dac1 CAYv'v ci N 4'1(14 0
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
a complete�ass'r�equired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller --.--ri (�\-- Signature of Seller
(.OrIrDP I.Casey v 9-19-16
Printed Name ofSeller Sian Date(Al M/DD/YYYY) Printed Name of Seller Sian Date(MM/DO/YYYY)
F.;BUYER(S)fGRANtEE(S) •APPI:ICATION;FOR,PROP,ERTYTAX•DEDUCTIONS-'IDENTIFY-ALLITEMS_THATAPPLY _ 1 __T- -_
Jav D. Breitweiser Mary S. Main
Buyer 1-Name as appears on conveyance document Buyer 2-,Name as appears on conveyance document
J.QC/(pl c - ;co 5.
Address(,4uihberp and dSStre t) Ao , •Im -an. reet)
^y
Y. 8
ll - -.......1 .1 -
Y�ES-// NO CONDITION I YES NO CONDITION
M ❑ 1.Will this property be the buyer's primary ❑I 3. Homestead SEP 2 3 2016
residence? Provide complete address of primary ❑ ❑V' 4.Solar Energy Heating/Cooling System
esaresidence including county: ❑ Cv/ S.Wind Power Device
Address(Number and Street) - LI ( " 6. Hydroelectric Power Dev
k U'- " GIHSO. COUNTY AUDITOR
City S[a:eZlPCode County
IJ tY' 7.Geothermal Energy Heating/Cooling Device
[� ❑ 2.Does the buyer have a homestead in Indiana to be ❑ 8.1s this property a residential rental property?
vacated for this residence? If yes, provide ❑ 21 9.Would you like to receive tax statements for this
complete address of residence being vacated, , property via e-mail?(Provide contact information
elow. Please see for orein information.
including county: m(,�,1'l/� OW 5 f f
7),11 \ 5I5 e; L J Wu-vi of liusbai pt available in all counties.)
4dress(Number and Street) _•/
u n(m5 i►� u-isa-� � s ab-14-20 -aoo - OW-7 si i-ct
City,State ZIP Code County
Primary property owner contact name E-mail