Homestead_Nimrick INDIANA SALES DISCLOSURE FORM SOF ID: Page 2
D.-:PREPARE1U‘ l'il" _,.•_YL.---Lif7T: 7 ," ;72-;,. 7::::7:.1;7,Crri.7 J..:
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 btiamw.twcbc.com
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S) . • -1 • ..
Jordan D Frederick
Seller 1-Name as appears on conveyance document Seller 2'Name as appears on conveyance document
5887E 115 S
Address(Number and Street) Address(Number and Street)
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and co,ete as required 1 by la% nd is repared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller
F ILED
s 6 arureolSeller
e
Jordan D Frederick 4-3D-It
Printed Name of Seller Sian Date IMM/OD/YYYY) Printed Name of Seller
-F.BUYER(S)/GRANTEE(S).-.APPLICATION FOR PROPERTY,TAX DEDUCTIONSIDENTIFTALL ITEMSOICHhtA9PH -. .: ." .. • 7 '--
Curtis Nimrick Samantha Nimrick
Buyer!'Name as appears on conveyance document Buyer 2'Name as appears on conveyance
106 W. Hamilton St. 106 W. Hamilton St.
GIBSON
Address(Number and Street) Address(Number and Street)
Hymera, IN 47855 Hvmera, IN 47855 ITOR
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
IZI 9 1.Will this property be the buyer's primary [ ) 9 3.Homestead
residence? Provide complete address of primary 9 171 4.Solar Energy Heating/Cooling System
residence,including county:
D a S.Wind Power Device
5887E 115 S
Address(Number and Street) 9 0 6.Hydroelectric Power Device
Francisco, IN 47649 Gibson 9 El 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
9 El 8.Is this property a residential rental property?
9 9 2.Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes,provide 9 2 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)
- L ? -3L -cbt .3 G5-Lma I
City,State ZIP Code County
Primary property owner contact name E-mail