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Homestead_Lucas
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D;,:RREPARER_L Leon C. Stone President Preparer of the Sales Disclosure Form Title 226 West Broadway Street Broadway Title, Inc. Address(Number and Street) Company Princeton, IN 47670 (812)386-1687 bti(ahmw.twcbc.com City,State,and ZIP Cade Telephone Number E-mail•!E.,SELLER(S)%GRANTOR(S); - — . -- . — — ) Mike Ellis Kyle Ellis Seller 1-Nome as appears on conveyance document Seller 2-Name as appears on conveyance document 509 Fast Second Street 509 Fast Second Street Address(Number and Street) Address(Number and Street) Hazleton IN 47640 Hazleton IN 47640 Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and corns •te .s rr+uired + pr red • accordance with IC S f •l::Lproperty Sales Disclosure Act". AIM Signature of Seller {/ Sign° r. ./Seller //�-Mike Fllic {/ ,� �/� • Printed Name of Seller Sion Date( M/DD Pdnte•Name of Seller Sian Date(MM/DD/TIM 'F:BU.YER(S)/GRANTEE(Sy ;APP,LIGATION FOR PROP RTY_TA-VDEDUGT,IONS_IDENITIF.Y ALL ITEMS THAT_A':P,Lti = _t Jennifer L. Lucas Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document 824 South Gibson Street Address(Number and Street) Address(Number and Street) Princeton, IN 47670 THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL Or1FrfSE THAT A• I YES NO CONDITION YES NO CONDITION -`/_ Is 90/� Q ❑ 1.Will this property be the buyer's primary 0 ❑ Gg4o 4 ead < residence? Provide complete address of primary ❑ © 4.Sat bj,- j, _..2 :. Cooling System ,1/ residence,including county: .. ❑ ig S.Wind PoWet Ft- e 309 South Ohio Street Or: Address(Number and Street) ❑ M 6. Hydroelectric Power Device Hazleton, IN 47640 Gibson ❑ M 7. Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ 0 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 ❑ 0 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) C (] City,State ZIP Code County Z 6- o 2 _S 9- °33 000 4 7 d/ Primary property owner contact name E-mail