Homestead_Cooper (3) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
Leon C.Stone President
Preparer of the Sales Disclosure Form Tide
226 West Broadway Street Broadway Title, Inc.
Address(Number and Street) Company
Princeton, IN 47670 (812)386-1687 btk( mw.twcbc.com
City,State,and ZIP Code Telephone Number E-mail
--- ----
Mark Russell Merla Russell
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
210 Anache Drive 210 Apache Drive
Address(Number and Street) Address(Number and Street)
Patoka IN 47666 Patoka IN 47666
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my kn 1 e i g nd IaI . S e,correct
and complete as required by law,and is prepared in accordance with IC . .1-5.5,"Real P it), - t al s,0I j i• Act".
/7 �taer - / — --a . _
' Signature of Seller Signature of Seller MAY 1 9 2017
Mark Russell 05/19/2017 Merla Russell 05/19/2017
Printed Name of Seller Sian Date IMM/DD/rvn] Printed Name of Seller Sian Date MM/DD
F:BU,YER(S)/GRANTEE(S) AP.PLICATIONEOR.PROPERTYTAX,DEDUCTIONS-_IDENTIEWALIsITFslt ==+ -
Jessie C.Cooper Frederick M.Cooper GIBSON COUNTY AUDITOR
Buyer I-Name as appears on cony ace document Buyer 2-Name os appears on conveyance document
C'"l� S. )S-b e"• q7.d. . )so e
Address(Number and Street) Address(Number and Street)
.r - - 4 • P 1cn/:
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS P:.' - . I ' ♦ ALL OF THOSE THAT APPLY.
YES NO CONDITION Y• NO CONDITION
❑ 1.Will this property be the buyer's primary [ ❑ 3. Homestead
residence? Provide complete address of prim. ,, _
� c� . eating/Cooling System
residence,inclu 'ng coun
� •
i/1 D > w ❑ 5.Wind Power Device
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
1r- a ....-Nt• µ-i LQ • • 0 0 7.Geothermal Energy Heating/Cooling Device
Ci ,State ZlPCode County
w ❑ 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 ❑ 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.
9 -7a c . 1s-1) a". Not available in all counties.)
Address(Number and Street) •
—s��- 1(.3210 C■sr- \-- (kr,— o if—as -3 — COo. c8 '-6\3-C)
City,State ZIP Code County
Primary property owner contact name E-mail