Homestead_Curl INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
:D P.REPARff _ - - -
DANIEL A.MOON ATTORNEY
Preparer of the Sales Disclosure Form Tide
116 S. MAIN ST- REEVES,COCHREN&MOON
Address(Number and Street) Company
PRINCETON, IN 47670 812/385-8641
City,State and ZIP Code Telephone Number
E-mail
;E>>SEIiLER'(S)%GRANTOR(S)i - -__:_=-::=--
-. _-- --- - -- - - - . - --
COUNTRY AYRE INC
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
7782 F Warrenton Road
Address(Number and Street) Address(Number and Street)
Unde penalties of erj I here certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and mplet a i I• • ry law prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
II fine of Seller . J Signature of Seller
PAVID F (;R WRFI / 14q -a 'A
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/UD/YYYI)
;F,BUYER(S)/,GRANTEE(S) APP,LIGATION_FOR.PROPERTYTAXLDEDUGTIONS=IDENTIFYALC.ITEMSITHATAFBLY_ -_
Marsha F. Cud
Buyer I-Name as appears an conveyance document Buyer 2-Name as appears on conveyaBgggt ��' u�pt
9969 Address s(Number Drive g�•-ECOy
Address(Number and Street) Address(Number and Street)
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE r^sC/
YES NO CONDITION YES NO CONDITION GIBBON COUNTY
IN ❑ 1.Will this property be the buyer's primary FJ ❑ 3.Homestead
residence? Provide complete address of primary ❑ NI 4.Solar Energy Heating/Cooling System
residence,including county: ❑
S.Wind Power Device
Address(Number and Street) ❑ NI 6.Hydroelectric Power Device
City,State 7lPCode canary ❑ 0 7.Geothermal Energy Heating/Cooling Device
Fl ❑ 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 ❑ Fl 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.
9969 Clearview Drive Not available in all counties.)
Address(Number and Street)
Haubstadt, IN 47639 GIBSON a /c- a 3-o 10- p aoo 000 p 4, Lo c9
City,State ZIP Code County
Primary property owner contact name E-mail
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