Homestead_Titzer INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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Bryceann Cutsincier
Preparer of the Sales Disclosure Form Title
226 W.Broadway Broadway Title. Inc.
Address(Number and Street) Company
Princeton, IN 47670 812-386-1687 btiemw.twcbc.com
City.State,and ZIP Code Telephone Number E-mail
E.SELEEk(S)/GkANTOR(S)-_::.' .: :::c-.,:, ;,_ .:;4:::' . 'ii, f'.-Ci..,--.ti-t?-.-•Tirt.ii5-;':' :2-7: .Iiini
Bradley J Simms Beth Ann House-Simms
Seller I-Name as appears on conveyance document Seller 2-Nome as appears on conveyance document
5175 9th MP 5125 9th Ave
Address(Number and Street) Address(Number and Street)
Hatihstadt IN 47619 Hatihstadt IN 47639
Under p alties of perjury,I here• certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and c plete as required b la .,and is prep.red in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
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gignature of Seller / Signature of Seller
T1Bradley I Simms Beth Ann House-Simms
Printed Name of Seller Sian Date 001/DO/YVTY) Printed Name of Seller IL/SE OWE/0M°
.F.BUYE8(S)/GRIANTEE(S) APP.LICATION:FOlt PROPERTY TAX=
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
El 0 1.Will this property be the buyer's primary 0 0 3.Homestead
residence? Provide complete address of primary 0 17 4.Solar Energy Heating/Cooling System
residence,including county:
0 Z S.Wind Power Device
512 S 9th Ave
Address(Number and Street) 0 v) 6.Hydroelectric Power Device
Haubstadt,IN 47639 Gibson 0 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
0
0 0 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 g 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)
dlo- a 3 -DC2 -Oco Eco-co9
City,State ZIP Code County
Primary property owner contact name E-mail