Homestead_Marvell _
la DIANA€ALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARERraW4-nraa�'�'�_.Lam.'-�.T%a°.x'1d-illncus6 .. ir tn vL �-.��,_.<— ... �,-,i.��:t r I...i �.�'.
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Prqares of the Sales Dis a re Form l Title
)— 9 R7 treat) Company
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Adds umber an treat) Company
(Ja.445t//1Lj TV 977//
City,State,and ZIP Code Telephone Number E-mail
ESEL:II?R'(S`%GRANT.OR(S]iiM_ .->na:..FY.i_..i,. .aAic... itiA:112` i4c.- __ . 2c.;k'e`.._. :� ,-3-il?g;`
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Sellerl Name as appears rs on cony yance da ment t Seller 2-Name as appears on conveyance document
NV? f/Pzt an? %J/Phi , g ,
Address(Number nd Street) Address(Number and Street)
f�)42-0- ////A W 7771/
Under penalties of perjury,l hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete requ red by la v,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
stgnamre o - er ( Signature of Seiler
g;(0 . : &cL-/ts(e/ n 3 -02g-/7
Printe Nameo let .. ' Sign'DatefMM/DD/YYYY) . Printed Name o(Seller Sign Date(MM/DD/YYYY)
F. � ESl elTlON'F ORP20IERTYAXDEDU��ION ' FrsA ° T f i ��tYys
Buye Nam/asappmrs o( eya� domen e�
Name appcaonronveyonce
gays w s+ Ai) 6 `
Address(Number and Street) Address(Number and Street) MAR 2 3 2017
pr,ntesom IN '/7670
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION `YEStt=`NI CONDm0N
• =KI ❑ 1.Will this property be the buyer's primary gl, ❑ 3.Homestead
residence? Provide complete address of primary ❑ KI 4.Solar Energy Heating/Cooling System
residence,including county: ❑
S.Wind Power Device
Address(Number and Street) ❑ 6.Hydroelectric Power Device
❑ f,Er 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ g4 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 ❑ 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(/) — 0 3.35-3oo-00I. 5as-oa?
City,State ZIP Code County
Primary property owner contact name E-mail
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