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Homestead_Blevins
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 !D..I?REP,ARER •C - '-- _ ,. 7---:7-1-- ..-J Leon C. Stone President Preparer of the Sales Disclosure Form Tide 226 West Broadway Street Broadway Title. Inc. Address(Number and Street) Company . Princeton, IN 47670 (812)386-1687 btl(ahmw.twcbc.com City,State,and ZIP Code Telephone Number E-mail !E•EL'LEIt(S)'/.GRAN:T,QR(S)r-- v , _ . - - —I Jeremy K Danek Seller I'Name as appears on conveyance document Seller 2•Name as appears on conveyance document 110 S Indiana Street Address(Number and Street) Address(Number and Street) Hazleton, IN 47640 Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowl:;a elVti correct and omplete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Prop:1� I D"spic77itre ct". Si re of Seth, - Signature of Seller OCT g O 2017 017 Jeremy K Danels fh/ ff Printed Name al-Seller Sian Date(MM/DD Y Printed Name of Seller _ Swan DateJMM/DD/YYI.1•I �F;a lgER(SI/.GRANTEE(S)'APP.L[GATION F,QRi PROER17YiTAX`D.EDUC TilONSt,IDEMUEY'ALLIITE_MSiTirrnAAklitrk . Matthew J. Blevins Shaynah L. Blevins GIBSON COUNTY AUDITOR Buyer I'Name as appears on conveyance document Buyer 2-Name as appears on conveyance document 110 S Indiana Street 110$ Indiana Street Address(Number and Street) Address(Number and Street) Hazleton, IN 47640 Hazleton, IN 47640 THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION YES NO CONDITION 0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3. Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: ❑ ri 110 S Indiana Street s.Wind Power Device Address(Number and Street) ❑ 0 6. Hydroelectric Power Device Hazleton, IN 47640 Gibson ❑ ( 7.Geothermal Energy Heating/Cooling Device City.State ZIP Code County Ici ❑ 2 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) City,stole ZIP Code County 0b oa _ 5Q- 033 -OM 2u 0 t 4 Primary property owner contact name E-mail