Homestead_Schapker INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
DYI REPARER ? i_ L _ r 1 `
Sheryl Holtz
Preparer of the Sales Disclosure Form Title
10652 E 1050 S
Address(Number and Street) Company
Lynnville, IN 47619 812-449-7397 sholtz @midsysserv.com
City,State,and ZIP Code Telephone Number Email
1E5SES:ER(S)/GRANTOR(S)' l
Roger V.Georges Gloria Jean Georges
Seller I-Name as appears on conveyance document Seller I-Name as appears on conveyance document
10904E 1050 S 10904E 1050 S
Address(Number and Street) Address(Number and Street)
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 wit. IC 6.1.1-5.5,"Real Property Sales Disclosure Act".
/2 ° - -
Sign d!ureofSeller Signature of Seller) /
Roger V.Georges Gloria Jean Georges l-
Printed Name of Seller Sion Date(MM/DD/1nYY) Printed Name of Seller Sian Date(M.N/DD/191f1
— f
[F;•BU,YER(S)`/,GRANTEE(S)''�APPLIGATION!F_OR��PROP,ERTY�TAX<DEDUCTIONS�IDENTIF,Y%ALLITEMcmu' � t
Micheal J.Schapker Glenda C.Schapker
Buyer Name as appears on conveyance document Buyer 2'Name as appears on conveyance me.. -1
9998 S 1225E 9998 S 1225E 2 Address(Number and Street) Address(Number and Street) AUG 2 1 LOU
Oakland
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 NO CONDITION
1 ❑ 1.will this property be the buyer's primary al ❑ 3.Homestead
residence? Provide complete address of primary
❑ 4.Solar Energy Heating/Cooling System
residence,including county:
❑ 19 5.Wind Power Device
Address(Number and Street) ❑ is 6.Hydroelectric Power Device
City,State ZIP Code County 0 7.Geothermal Energy Heating/Cooling Device
❑ 12 2.Does the buyer have a homestead in Indiana to be ❑ 8.1s this property a residential rental property?
vacated for this residence? If yes,provide ❑ 12 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) [y� -coal Micheal J.Schapker�f„- 90 �S-300 -cc '/t1�t�.yl
City,State ZIP Code County VV
Primary property owner contact name E-mail