Homestead_Smith (2) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER
James G. McDonald, III Attorney at Law
Preparer of the Sala Disclosure Form Title
120 S. Main Street McDonald Law Office
Address(Number and Street) Company
Princeton, Indiana 47670
City,State.and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S)
Herb 0 Gray Sara Jayne Gray
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
P O Box 157 P O Box 157
Address(Number and Street) Address(Number and Street)
Patoka Indiana 47666 Patoka_Indiana 47666
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 Properttyy Sales Disclosure Act".
:- -_-#--L9 sb:fr- a
Signature of Seller Signature ofSeller
- , • .. O- 06 3., Zul Sara Jayne Gray c4/3e12u17
Printed Name of Seller Sian Pate H4 /DD/YYYY) Printed Name of Seller IL to(MM/oD/YYY11
F.BUYER S /GRANTEE(S)-APPLIC•TION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL 1 S T A Y
6 •tt A.Smith
ever i- ame as appears on conveyance document Buyer2-Name as appears on conveyance dq`um nt
201 N. Main Street - JUU 3 2017
Address(Number and Street) Address(Number 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 APPLY.
YES NO CONDITION I YES ON
LW ❑ 1.Will this property be the buyer's primary //[� ❑ 3.Homestea
residence? Provide complete address of primary K. ❑ 9" 4.Solar Energy Heating/Cooling System
residence,including county: ❑ Q
5.Wind Power Device
Address(Number and Street) ❑ ['1 6.Hydroelectric Power Device
,smte ZIP County
0 7.Geothermal Energy Heating/Cooling Device
Ciry,
❑ Re 2.Does the buyer have a homestead in Indiana to be ❑ B.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)
A -oy- ay -3oy - aor. 14,3 -o .1-o
City,State ZIP Code County
Primary property owner contact name E-mail