Homestead_Smith (76) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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Preparerofthe Sales DisclosureF Tide \�.s,�/}{�- 1 \ /�y�/,-^
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City,State,and ZIP Code Telephone Number E-mail
E.,SEf L'ER S)'/,GRANTOR(S),_ — — --- - - -- --______
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•Seller I-Name as app.,non conveyance-. ment Seller 2-Name as appears on co veyance documen
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Address(Number 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 plete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
-•nature ofSelle/ Signature ofSeller -/
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Printed Name (Seller ign to(MM/DD/YYYI) Printed Name of Seller S' n Date(MM/DD/YYf)
;;F:BUNIER(S)/GRANTEE(S)1°APPLICATION;FOR PROPERTY_TAX,DEDUCTIONS=IDENTIFY ALL ITEMS THAT APPLY
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Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
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Ad (Numberand5veer) Adores(Number and Street)
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THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE Tt1.1JY/jt?�p�,-���.r
YES NO CONDITION YES NO CONDITION GIBSON COUNTY AUDITOR
iy" ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary ❑ N. 4.Solar Energy Heating/Cooling System
residence,including county: ❑
5.Wind Power Device
Address(Number and Street) ❑ 6.Hydroelectric Power Device
❑ 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ 0 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)
ac- la-012-103- 0a .53(/. 0g
City,State ZIP Code County -
Primary property owner contact name • E-mail