Homestead_Thorbecke INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
Llii;P.REPARERt`w ,r a_ : - T7T. T 4.,.7717 2 , 1-±i, l` _ R —7. _ ;0, .T , .
Ray M.Druley Attorney No.4759-26
Preparer of the Sales Disclosure Form Title
505 N. Church Street, PO Box 146 Law Office of Ray M. Drulev
Address(Number and Stmt) Company
Fort Branch. IN 47648 812-753-4975 druleylaw(a)yahoo.com
City,State,and ZIP Code Telephone Number E-mail
(EiSELLER(S)'A6RANTtOR(S)) .• 7-V-=- ; .. 77- .- . T - kf ti
Corey B Wayman
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
102E Evans St
Address(Number and Stmt) 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
and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
LdvJJ/ WWjs---'-
Sign eeafSeller / Signature of Seller
Corny R Wayman 4/5/2017
Printed Name of Seller Sign Dare(MM/DD/YYYY) Printed Name of Seller Sian Date(MM/DD/YYY11
.ETBUXER(SYGRAN;TEE(S) APPLICATION FOMPROP.ERTLY CTAXIDEDUGT10N5_.IDENTIE,Y(All ITEMSiTHATrAP,PLYt _ -.1--.1i7.77,
Patricia A.Thorbecke •- .
Buyer 1-Name as appears on conveyance document Buyer 2-haute as appears on conveyance document
105 W.South St..Apartment A _ _d Si: i�
Address(A'umberand
Street) Address(Number and eet)
Fort Branch, IN 47648 _
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOaiSkY •
YES NO CONDITION YES NO CONDITION Al
residence? CON/yqU4NN10 jFl II 1.Will this proper the buyer's primary Fl ❑ 3.Homestead
db comp s primary 0 0 4.Solar Energy Heating/Cooling System TO R
residence,including county: ❑ NI
102E Evans St 5.Wind Power Device
Address(Number and Street) ❑ Q 6.Hydroelectric Power Device
Fort Branch,IN 47648 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
El El 2.Does the buyer have a homestead in Indiana to be III 0 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.)
Address(Number and Street) �//_ J��j {/p
City,State ZIP Code County
` 62 —/" _r741 OM°9 MO 7510 a�
Primary property owner contact name E-mail