Homestead_Broshears (4) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
LTIRRWARERZ;74::;"77---iiiTa?-1;,:zjaM:r..,77:wAFILIEM-17,-1775T-77Cs.CT:Agrt.7-7;i7.17- '477(PR5.4.--Wa.T:•=7Cn7i,T. ;:q."=;$C--:-Y:;
Leon C. Stone President
- --
Preparer of the Sales Disclosure Form Title
226 West Broadway Street Broadway Title, Inc.
Address(Number and Street) Company
Princeton, IN 47670 (812)386-1687
City,State,and ZIP Code Telephone Number E-mail
Iie7SELBER(SVGRANT.CIR(S)ti17.1 :.v.:=1.L.TIL:77. 7c—_.:44-:-TT:7CF 7-`' .-- -' -■',.. 1777..fr.7-47.':.,-,-7,1:=7=1"-.7,-7:-7-.r77:,-.7- 1;
lamps W Rroshears .Ir .IPAPIPHP H Rroshears
Seller I-Name as appears on conveyance document Seller 2-Nome as appears on conveyance document
510 West Morton Street 510 West Morton Street
Address(Number and Street) Address(Number and Street)
Oakland City IN 47660 Oakland City IN 47660
Ciry,State,and ZIP Code City,State.and ZIP Code
ria - 9-519-7,5229 if2 - 2ger-3R79
Telephone Number E-mail Telephone Number E-mail
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
an.Ag, plete as requi ed y law,and is prepared in a ordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
.ra -cyz...e.4- , -ne„tee- -N. 644,464_,L41—
Xgnature of Seller Signature of Seller
James W Broshears Jr / 3-13 -ill Jeanette H Broshears / 3 -/3-1 7
Printed Name of Seller Sian Date(MAI/DOMYY) Printed Name of Seller Sian Date(MAUD WITYY)
:Fi MU Y ERP/GRANTEEMTARPLICATIOMEOFRROPERTYLIT AXiDEDUCTIONSEIDENTIEYMEIRTEMSOHNIMPPLYT;7-c>
Paige Broshears
Buyer!-Name as appears on conveyance document Buyer 2-Name as appears on conveyance
811 West Oak Street
Address(Number and Street) Address(Number and Street)
Oakland City, IN 47660 Ste, „......,pa
City.State,and ZIP Code City,State,and ZIP Code Ur 1
(91R) SR'S- 6' 'IC e
Telephone Number E-mail Telephone Number oin e . , E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF TH%a . Y.
(.41,
YES NO CONDITION YES NO CONDITION .0>
Z 0 1.Will this property be the buyer's primary Z 0 3. Homestead i&
residence? Provide complete address of primary D 2 4.Solar Energy Heating/Cooli0/7.n24ystem
residence,including county:
0 IN S.Wind Power Device
811 West Oak Street
Address(Number and Street) Di Z 6. Hydroelectric Power Device
Oakland City, IN 47660 Gibson El IZI 7.Geothermal Energy Heating/Cooling Device
Ciry,State ZIP Code County
0 F4 8.Is this property a residential rental property?
0 [7] 2.Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes,provide 0 g 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.)
Address(Number and Street)
a ICI— 3-i 3 - - Extiaga-DOP?
City,State ZIP Code County
Primary property owner contact name E-mail
Under penalties of perjury, thereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".(Note:
Spouse information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
being filed.)
C - • ,_.._ _
.._
Signatur• .f Buyer) Signature of Buyer2/Spouse
Paige Broshears I-1 ---/'7
Printed Legal Name of Buyer I Sign Date(M.4/00/M11 Printed Legal Name of Buyer 2/Spouse Sign Date(MM/DD/YYTY)
4;2— 765'e a-eveY
Last S digits of Buyer 1 Driver's State Last 5 Digits of Social Security Number Last 5 digits of Buyer 2/Spouse Driver's State Last 5 Digits of Social Security
License/ID/Other Number Number License/ID/Other Number