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Homestead_Cook
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 T. �Z.L f. ,TT-.�--j :r .73 L- .L-.�yr -CT"-ST'"-1 i - !Y" -7:7 3`- ,D::P,REPARERF � •�y"r:i' �.�_ s}. �sf�:.st � : ' � � —= r_ .a_•� : -� c�b�� ra _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(dhok-law.com City,State,and ZIP Code Telephone Number E-mail .tntil;ER(S)'/.GRANTOR(S1=_... :iu-". . ,,"v. a7 -7 3 1 . ..so-.t_& =`r 1-r,- ,:.� . , +y Dennis R Green Shannon I Green Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 9018 F 400 S 9018 F 400 S Address(Number and Street) Address(Number and Street) Under penalties of perjury, 1 hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and con)a ete as req fired t_ law,and is prepared in accordance with IC 6-1.1-5.5,"Real Pr erty Sales Disclosure Act". t, y� /` Signature of Seller Si nature of Seller Dennis R Green 03/09/2017 Shannon L.Green 03/09/2017 Printed Name of Seller Sipn Date(MM/DD/YrrYJ Printed Name o(Seller Sian Date(MX/DD/YflYI F.:BUYER(S)/.GRA<\T @EIS);;AP,PLICATION]FOR?PP,ROP,ERT,YLTAXtDEDUCTIONSt4II)ENTITY-AL'li,ITEMSiTHAT AP.PGY/- ,A.T_ , . Mistie M.Cook Buyer 1'Name as appears on conveyance document Buyer?-Name as appears on conveyance document 402 E.Main Street Address(Number and Street) Address(Number and Street) Francisco,IN 47649 ' THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY. 1 I 7 YES NO CONDITION YES NO CONDITION C/esu� <Oi ❑ 1.Will this property be the buyer's primary Q ❑ 3.Homestead /V COO, residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cool' residence,including county: ❑ 5.Wind Power Device HOC/T 402 E Main Street OR Address(Number and Street) ❑ WI 6. Hydroelectric Power Device Francisco, IN 47649 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County El El 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rental property? vacated for this residence? If yes,provide ❑ 0 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.) ZAddress(Number and Street) /�-/j-a0-/O/- Qcoi odi9 Mistie M.Cook City,State ZIP Code County Primary property owner contact name E-mail