Homestead_Clampet INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D`1?REBARER— - --
\LICIA L. MEADOWS Settlement Agent
Preparer of the Sales Disclosure Form Title
362 Woodward Avenue Title Source, Inc.
Address(Number and Street) Company
Detroit, MI 48226 (313) 877-1000 PURCHASE @TITLESOURCE.COM
City,State,and ZIP Code Telephone Number E-mail
ESELLER{S)%GRANTO RCS) ...-_-.7.-1 -2---- : =— = - ==
Richard E. Hedge
Seller I -Name as appears on conveyance document Seller 2•Name as a
ppears on conveyance document
402 W Grave St .
Address(Number and Street) Address(Number and Street)
Patoka, IN, 47666
Under penalties of perjury,I hereby certify that this Sales Disclosure, to the best of my knowledge and belief,is true,correct
a co tplete as require I w,and is prepared in accordance with IC 6- 1.1 - 5.5,"Real Property Sales Disclosure Act".
Signature of Seller Signature of Seller
Richard E. Hedge S/301)/7
Printed Name of Seller Sign Date( YYYY) I Printed Name of Seller Sign Date(MM/DD/Y7T'Y)
F..BUYER(S)/GRANTEE(Sj APPEICATION.FOR PROPERTY--TAX-DEDUCTIONS_IDENTIEWALL ITEMSTHAT APPL Y
Quinton J. Clampet Cor,,i't„Py C/Grope*
Buyer I -Nome as appears on conveyance document Buyer2 -Name as apl(fears on conveyance document
402 Grave St W ye-4 &7r2L,Ne 574 1J
Address(Number and Street) Address(Na her and Street)
Patoka, IN, 47666 �
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT A BIM,/ 9
YES NO CONDITION YES NO CONDITION
05 cu/7
NI 0 t-Will this property be the buyer's primary
residence?Provide complete address of ❑ 0 4. Solar Energy Heanngt I t c des, .tem
primary residence,including county: y
*,z 6) Gra✓-e 5i. ❑ D 5.Wind Power Device AUDITOR
Address(Numbe•and S)5e G�` ��� El 6. Hydroelectric Power Device
y l ''7bd 4 ,' ❑ 0--7.Geothermal Energy Heating/Cooling Device
City,Smte ZIP Code County t�
❑ 0 2. Does the buyer have a homestead in Indiana to be ❑ u�8' Is this property a rental property?
vacated for this residence?If yes,provide ❑ Er 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) l �(
City State County A �- 0L( . 5 /0 / G603,6a, ��__
h y Primary property owner contort name E-nail