Homestead_Mason (3) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER
Vinod C.Gupta
Preparer of the Saks Disclosure Form Tide
17962 Foxborough Lane
Addrea(Number and Saar) Company
Boca Raton, FL 33496 • 561-487-2742
City,Stott and VP Cede Telephone Number E-mail
•
E.SELLER(S)/GRANTORjS) I
Vinod C Gupta
Seller I-Name as appears on conveyance dotnmeot 1 Seller 2-.Name as appears an conveyance document
17962 Fnxhnro:lgh Lana II
Addrm(Number and Street) Adores(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°.
Signature of Seller Signature vlSeller
Vinod f. Genie 3 • 23_ - t7
Printed Name((Seller Sian Date fluM/an/YIYYI Primed Name of Seller Sian Date I.Y4/DDITYI'II
F.BUYER(S)/GRANTEE(S1-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
C --", Jon K.Mason Michelle R.Mason in E r)
\`-'-a.+I art=Smx=appears on mn.yvnte davmen: Ru}a2-Name as appmrsoa co.1, u e,.act •en
622 E Walnut Street 622 E Walnut Street
Address(Number and Street) Adorers(Number and Street) -
Oakland City. IN 47660 Oakland City,IN 47660 APR 17.2017
City,State,and ZIP Code City,Stott;end7JP Cade n
Telephone Number E-mail Telephone Number p__.._ Email
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY'ALL OF C�.1e..+$Oisf rCY,O'(`�NTYY,,AUDITOR
YES /ft0 CONDITION I YES SO CONDITION
l' ❑ 1.Will this property be the buyer's primary J ❑ 3.Homestead
residence? Provide complete address of primary I L/ 4.Solar Energy Heating/Cooling Syst .
residence,including county:
4,u 5 : W/1_/Ivvt_,S_t_Gk±41Hht dc,*rI'l— ❑ C o.Wind Power Device
Street)(Number and Strt) e./704 0
❑ E-<, 6.Hydroelectric Power Device
61:5od✓ ❑ E 7.Geothermal Energy Heating/Cooling Device
State ZIP code Cuuoty
❑ [.1 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.
I' Not available in all counties.)
Address(Number and Street) " — '/3-/ 9- e Oa_-coo- s
us 001
32)v• 14(che(e
(V I soy
Can..State ZIP Code Cnuaty
Primary property ounercantact come E-mail