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IYB3IANA•SALES DISCLOSURE FORM SDF ID: Page 2
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,PREARER"- -_ .-..� ��ems.,_ -'_�=_•.a :'�<3�-.,c-_.c,:-:�-_�s �'�..s f^fi..a_r_-�_+_ �'�-* x_:. .. z'�.,f-��-�.s��r;�..•.
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Preparer of the Sales Disclosure Form - Title
330 t Secut z s# .
Address(Number and Street) Company
(�rincd-TOn N ieN -1 )6) 6 gI2.- (077- 4(66
City,State,and ZIP Code Telephone Number E-mail
5SEf;�r�- s 'GRANNT.oa fi3' .* ';o- 1-4 v- :^k.S�.�a ic' r�: -._.s,s"r'.eZi S,^- '^_?.a 'I A_..: _: M ?st'-yam ,._ �` �-:�.`�.-_u
Seller I-Name as appears on cony rice document Seller 2-Name as appears on conveyance document
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Address umber and Street)/ Address(Number and Street)
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Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and co n-pl� uir�d py lawA is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signs r of Seller ( Signamre of Seller
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- Printed Name ofSeller Sian Dare(MM/DD/YYYY) Printed Name ofSeller Sian Date(MM/DDMTV)
IF:`BUY ER(S)/GRANTEE(S) APPLICATION EOR(PROP.ERTcY;TAXDEDUCTIONS ;IDENTIFYALLITEMSTHAT:APPLY;,;.s -.-: Val:
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Buyer I-Name as appears on conveyance document Buyer 2-Name as appears an conveyance document
330 E. yr(lce -i - 330 E. 5Ps cJ c-e S+ -
�ress(Number and Street) Ad ress(Number and Street)
I riffRiOn iN (-1-) (
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT A�P 1'. Fili
YES NO CONDITION I YES NO CONDITION llp s 1e GX , J�L.JN
la ❑ 1.Will this property be the buyer's primary ❑ 3.Homestead �n
residence? Provide complete address of primary ❑ ® 4.Solar Energy Heating/Co4Ri g 4ystePI1
residence,including county: ❑
33o C . 5c'rU(.e 34- • S.Wind Power Device �
Address(Number and Street) ` ❑ [xi 6.Hydroelectric Power De4i�-
Pi?n cP(-On 1 N ((76-I C GcbS Or^ ❑ 03 7.Geothermal Ene(gEISONrVOILIb ifg AWIdWOR
City,Stare ZIP Code County
(fl ❑ 2.Does the buyer have a homestead in Indiana to be ❑ Q 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.
q041 /0. 5( i11cry St- Not available in all counties.)
Address(Number end Street)
PC i A(_P inn 01/ 9-16270 (9:1/2'5 —0\017(901 - W Q9'
City,State ZIPCode County
Primary property owner contact name Email