Homestead_WillisINUTANA SALES UISCLUSUKE FURM SUF IU: Fa e 2
D. PREI'ARER �
. Kim Miller Escrow Closer
Preporer o([he Sales Disdosure Fom, Title
�331 Franklin Street Tiile Center oi Indiana
AAdress (8umberond Sveet) Company
Columbus IN 47201
E-mail
E. SELLER S GRANTOR S
Reth A Davidson fartnerly knows as Balh A Oeborn Joce�/n A Abel
Selie�]�A'ameasoppmrsonconveyanredotummt Sdfer..�Namea appearsonronveyanre rument
i ��,s w �oo �s t�i'Z �t ��reqoru '�-a-r�e
Address /Numberand Svee[J Addr s(,YUmber and Svee
��ENSv,���, T„�. �7��s �-��. veYn�n, z� �I��zo
E-mail
Under penal[ies of perjury, 1 hereby certify [ha[ this Sales Disclosure, [o the best of my knowledge and belie(, is true, correct
and �cf�`'ple[e as req'ufired by law, and is prepared in accordance w' IC 6d1•5.5, "Real Property �ales Dis osure Ac[".
✓"/f�-,�.�, ��wc42en)
SiynamreaJSeller Si n reo(Seller
Beth A Davidson 4-4-2017
PnntedNameo75e/ler SipnDa[eMMOD eolSelfer SianDa[e1MM/oD/n
mronveyanoedocvmmt '-Nameasappmrso nveyonred«vmenr
2219 221
Address(Numberond5treet) Address(Nvmberan )
Ft Branch IN 47648 Ft Branch IN 47648
�Ciry.Smre, andZlP Code CiN.Smre, and ZIPCOde
� �
�° Tel¢ honeA'umber E-mail Tefe hmeNUmber E-mail
THE SALE$ 015CLOSURE FORM MAY BE OSED TO APPL\" FOR CERTAI \ DEDUCfI0R5 FOR TNIS PROPERTY. IOE\TIFY ALL OF TNOSE TMAT APPLV.
YFS \0 CO\01T10\ \O CO.�'DITIO,V
�✓ � 1.1Nill this property be the buyer's primary Q ❑ 3. Homestead
residence? Provide complere address of primary Heating/Cooling System
residence, including county:
5. Wind Power Device
R7fi5 W 400 S
Address(Numberond5vee[) ❑ ❑✓ 6. Hyd�oelectric Power Device
Owensville IN 47665 Gibson � Q 7. Geothermal Energy Heating/Cooling Device
Ciry, 5[vre ZIPCade Counry
✓Q � 2. Does the buyer have a homes[ead in Indiana to be � � g� �s this property a resideniiat rental properiy?
vaca[ed for this residence? If yes, provide ❑ ❑� 9• Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail? (Provide conmct informotion
including county: belo�v. Please see instructions%r more informa[ion.
2219 E 750 S Not availa6le in all counties.)
Address (Number and Stree�J �t/ /J q �
Ft Branch IN 47648 �—/Q '�(p—�Q� a0� 0 /�Q �'—/
Ciry. Smte ZIP Code Counry
Primary pro➢erR• owner ronmr! name E�mail
Under penalties of perjury, 1 hereby certify that this Sales Disclosure, [o the bes[ of my knowledge and belie(, is [rue, correct
and tomplete as required by law, and is prepared in atcordance wi[h IC 6-1.1-5.5, "Real Proper[y Sales Disclosure Ac[". (No[e:
Spouse informa[ion, Social Security and Driver's License/Other numbers are no[ necessary if no Homestead Deduction is
bei filed.) � �� p n j
? I a. _1L �. t y' 1_ ?'_!'o (:�LYtiti �S r(/ ��2
Signamreo(Buyerl Signamreo( vyer2/Spouse
Amanda K W'llc 4-4-2011 Christopher S W�IIe 4-4-2071
�
SorialSecuriry
license/ID/Other�\'umber Number License/ID/Otherh'umber