Homestead_Cashin j` -
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
:D.:PREPARER .;.- i <-.;
Kelly J.Jackson Attorney
Prepare of the Sala Dudotvre Form Tide
20 N.W.First Street.Ninth Floor.P.O. Box 916 Ziemer.Stavman,Weitzel&Shoulders.LLP
Address(Number and Street) Company
Evansville. IN 47706-0916 (8121424-7575 Kiackson(ahzsws.com
City,Scam and VP Code Telephone Number E-mall
Vicki J Perte
Seller I-Name as appears on conveyance document Seller 2-Name as appears an conveyance document
101 Onwning St Unit F
Address(Number and Street) Address(Number and Street)
Panama City Reach FL 32413
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and c mplete as re fired by law,and Is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature Ctrso/$ell 1C c , Signature ofSeller
Vlrri t Peete a,Date l i ;5..
Printed Name of Seiler S(qn Date 11201/YrYYI Panted Name of Seller : i S i t MN/DO/MY)
/':F.BII1'FR(S� GRANTEES)-_ APPLICATIDN'FOR'PROP:ERTYTaX DEDUCTIONS..=eIDENT1FYiY1I:L 1 5:24. �.y.l "_ _,..5-'��•�='�•I I t -• i-, t 1 .
�•�-: I-Name•. •----rs on conveyance document - Buyer 2-Name as appears on conveyance d-413" 1
611 W.Cherry Street 611 W.Cherry Street
Address(Number and Street) Address(Number aad Street)
Oakland City,IN 47660 Oakland City. IN 47660
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDrnON YES • onaorrioN
Z ❑ 1.Will this property be the buyer's primary !'4 ❑ 3.Homestead
residence? Provide complete address of primary IN r4 •, e • 3 eating/Cooling System
residence,including county: ❑ ❑ 5.Wind Power Device
Address(Number and Street) ❑ z 6.Hydroelectric Power Device
❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ Z 2.Does the buyer have a homestead in Indiana to be ❑ m 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ p 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.
'a oval aeeln0 cou r- .
Address(Number and Street)
, G _ fy_i8 403 - 000. (DS3 -oo
C/ry,Stare LP Code County
RiS ry property owner contact name