Homestead_Reavis INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
1175.4f REPARER R=_ _� _ _ t- .. irs .-_ `2 a- - ,.` [c ' s' " .n, :_ t _ ate Mv; a
Rebel M . L to
Preparer of the Sates Disclosure Form Title
lo 007— 3✓bw eboro Pan,-blQa- i'O1tiI
talSELLER(SliGRANTOR(SniTt.7 ,-._._-.,-,rr..aka *9 - e ,,e-:,-_ . _ "r c= :1 , i
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(Seller I_Name as appears on conveyance document tSelen2--Name as appears on conveyance document
11-/UL/ 5, iroac Dr 17-1-0-11-i 6- &TOY >r.
Address(Number and Street��)l/, yy O Address(Number and�Street)
..{- 1.+1c07-3°7
Np46514dY1 / h t.Q(Q 3 / t-h ut ✓eI nLI ' J 1 N
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Under penalties of perjury, 1 hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and compl-te as required by law,and is prepared in accordance with IC 6- .13.5,"Real roperty Sales Disclosure Act".
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(ignatureofSellen L igna/u of Seller
6c 13 3 pa f . r -� fa/3.�/-at,.�� _ Kri5%enf R. h.venpor+ O(D/ZL�2017
I Printed Name ofSeIef) LSign.Date(rim/Da/rrrij ( Printed Name o Seller LSi Date M /n0 I
Pi
THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPL'
Y NO CONDITION
❑ YES NO CONDITION �b
1. [his' ro er be the buyer's er's primary v
p p ty y p ry (� ❑ 3.Homestead
residence? Provide complete address of primary El 4.Solar Energy Heating/Cool Se9seerp
residence,including countyf- ❑
S.Wind Power vi�qcce�, Of �IJ
Address(Number and Street) ❑ 6.Hydroelectric PoG€b )!', - 0,
n
❑ 7.Geothermal Energy Heat' :1 e •: D• -e
y,,State ZIP Code County
❑ 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rent4al .perty?
vacated for this residence? If yes,provide ❑ 9.\Mould you like to receive tax statemenRgo this
complete address of residence being vacated, property via e-mail?(Provide contact information
cl coun
? q' below.Please see instructions for more information.
•0 ` g ti 1 Z �- 1 Q Notes i(q�Oin all counties_) 9
(�Addres Number an treet) 45-1(-6-0 ^ 3 J o0o ti 4
\� A e i n lung, 1. f -, RzaJ 5 no✓1L'
�= \_ c p� Caunry
Ciry,StateTIP Code
Primary property owner ronma name E-mail