Homestead_Purkiser II INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
0 P,REP.ARE14. _: ,. _: — ,-:. --- . . . _.T_ s_ "-r. _ ., _ .:, - �-. ,-
1 )i sk(an+ aincin 1 cat L,-,/-• s DEED PREPARER
Preparer of the Sales Disclosure Form Title
1000 Abernathy Road NE Building 400, Suite 200 PREMIUM TITLE SERVICES,INC
Address(Number and Street) ' Company
Atlanta,GA 30328 (770)612-7007
City,Stale,and ZIP Code Telephone Number E-mail
E?SE ITER(S)/GRANTO tM Tilt. _.,_:. .-F' — "`" -
DEUTSCHE BANK NATIONAL TRUST COMPANY(See Fxhibit-M
Seller I'Name as appears on conveyance document Seller 2-Name as appears on conveyance document
CIO OcwPn I oan Servicing LI C 1661 Worthington Road Suite 100 •
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 re 7 ired byq layt and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller ' 1 /V.'^Y�` c� Signature of Seller
Rafael Gonzalez D-7t'1
Printed Name of Seller Sian Date(MM/DD/YYYY) Printed Name of Seller Sian Date(MM/DO/m'r)
iEZBUYER(Sf'/,GRANTEE(S)''A IRICATION FOR;PROP,ERTYi,TAX1DEDUCT10NS 1DENTIEYr'LL,ITEMSt T+ VYi" ' :'
JACKIE BRUCE PURKISER II
Bvyerl-Nameas appears on conveyance document Buyer 2-Name as appears on conveyance document
701 S Gibson Street SFP S
Address(Number and Street) Address(Number and Street)
20
YES NO CONDITION I YES /NO CONDITION
❑ 1.Will this property be the buyer's primary Ltd E 3.Homestead ,7rS
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
residence,including county: ❑
701 S Gibson Street 5.Wind Power Device
Address(Number and Street) � / ❑ 0 6.Hydroelectric Power Device
Princeton, IN 47670-2607 Gi 6 SOil ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
El IN 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 ❑ El 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) Zip—I a •0 7- '90 3- coo //// - Oa (S
JACKIE BRUCE PURKISER II
Ciry,State ZIPCode County
Primary property owner contact name E-mail