Homestead_Whitehead INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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Roman Ricker Attorney
Preparer of the Sales Disclosure Form Tide
P.O. Box 13. 219 N. Hart Street Partenheimer, Kinkle&Ricker
Address(Number and Street) Company
Princeton, IN 47670 812-386-0050 rricker(@hpk-law.com
City,State,and ZIPCode Telephone Number E-mail
'.Ee•SELLER(S-1/GRANT.01{(Slaris:Lii,-.:t.±;%7,„--,,:::::,,_:.4 YLii-iiL,2:2.;.7., "122Th--;:7: r- -•.:---‘1-1"-7177 P77771T -4 7
Dennis W Black Catherine R Black
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
PQ Box 328 P0 Box 328
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
V
mplete as required by law,and is prepared in accordance wi IC 6-1.1-5.5,"Real operty Sales Disclosure Act".
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Signature of Seller Signature of Seller
Dennis W Black 03103/2017 Catherine R Black 03/03/2017
Printed Name oTheller Sian Date(MAI/DIVYYVI) Printed Name of Seller Sion Date(MM/DO/fly)')
W•!13U.YER(SVGaANTEE(SypAPP.E1EATIONTROFP.ROPERTYLIA*DEOUG-TIONSIIIDENTIFYiALEITEMS3HAVARRLY• .•'t•I. . i- • - -1
Cindy L.Whitehead Gerald D. Richey
- - —
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
527 E.Water Street 527 E.Water Street
Address(Number and Street) Address(Number and Street)
.4
Princeton, IN 47670 Princeton, IN 47670 /1940
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APA.0 ---0-•
0,,
YES NO CONDITION YES NO CONDITION '
0 111 1.Will this property be the buyer's primary 0 III 3.Homestead Alch.,
residence? Provide complete address of primary D 121 4.Solar Energy Heating/Cooling System 0,9
residence,including county:
D 12 5.Wind Power Device
804 S Old Patoka Road
Address(Number and Street) 0 z 6. Hydroelectric Power Device
Patoka, IN 47666 Gibson 0 V] 7.Geothermal Energy Heating/Cooling Device
City,State ZIPCode County
0
D IN 8.1s this property a residential rental property?
D 2.Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes,provide 0 117j 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.
527 E.Water Street , Not available in all counties.)
Address(Number and Street) aZ-6)te-o?..17 *too-600.,J757z- Oda
Princeton, IN 47670 Gibson Cindy L.Whitehead&Gerald D.Richey
City,State ZIP Code County
Primary property owner contact name E-mail _