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INDIANA SALES DISCLOSURE FORM SDF ID: • .. __ Page 2
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Timothy Bottoms ' Sheriff
Preparer of the Said Disclosure Form Title . .
112 E EmersoniStreet Gibson County Sheriffs Office
Address(Number aid Street) Company
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Princeton IN 47670 812-385-3496 •
City,State.and ZIP Cxle Telephone Number E-mail
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:El,SELL ER(S)/GRA N TOR(Slah'%-ierS-ilat;;W-4:2-7 SALktga---i .. .;.-ft-M .:,:-5---;'5 :"Jitrn .-. 1.;'
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Sheriff Timothy Bottoms '-
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
112 E Emerson Street .
Address(Number and Street) Address(Number and Street)
Princeton IN 47670 • '
Under penalties of perjury.I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and corn 1 tte as required by law .nd is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller Signature of Seller
Timothy Bottoms 4/20/2017
Printed Nameopeller • Sign Date(10i/DDIYYM Printed Name ofSeller Stan Datem „tort
-FeBUYER(S)/GRANTEE(S) APPLlCATlON FOR PROPERTY TAX DEDUCTIONS:!IDENTIFY ALIFI APPLY, .f--,,---ri
Justin M Racirte
' Buyer 1-Mrre as appears on conveyance document C
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Buyer 2-Name as appears on cony ce ET)
703 N West St
Address(Number and Street) / Address(Number and Street) APR 28 2017
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Princeton IN 47670 .1
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YF Pal CONDITION
TA El 1.Will this property be the buyer's primary 15I 111 3.Horne-sre3r) .
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residence? Provide complete address of primary ' 0 rA"' 4.Solar Energy Heating/Cooling System
residence,including county:
0 is 5.Wind Power Device
Address(Number and Street) 0 Fl 6.Hydroelectric Power Device
0 TA 7.Geothermal Energy Heating/Cooling Device
Clry.State ZIP Code -County
8.Is this property a residential rental property?
111 IN
0 0 2.Does the buyer have a homestead in Indiana to be
• vacated for this residence? If yes,provide 0 TA 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)
City,State ZIP Code County
Primary property owner contact name E-mail