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Homestead_Willis
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 rDyP,REP.ARER' tx=r_: .F Win=;. s tt - -:4 , t: . :7 4 :.._ Roman Ricker Attorney Prepa rer of the Sales Disclosure Form Title 219 N.Hart St., P.O. Box 13 Partenheimer,Kinkle& Ricker Address(Number and Street) Company Princeton,IN 47670 812-386-0050 rrickethpk-law.com City,State,and ZIP Code Telephone Number E-mail KSELLER(S/.GR't IFOR(Sir :)" :1. y �---_' ` j_� ,,A : . 5s' - ...:: . . - . . James A Dame III by Charlene A Dame Attomey-in-Fact Charlene A Dame Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document 8372 F 900 S 8372 F 900 5 Address(Number and Street) Address(Number and Street) Flberfeld IN 47613 Flberfeld IN 47613 ' 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 with IC .- "Real Property Sales Disclosure Act". �� a - Signature• ' er Signature a Seller James A Dame III by Charlene A Dame 12/1/2017 Charlene A Dame 12/1/2017 Printed Name of Seller Sian Date(MM/DD/YYYY) Printed Name of Seller S(qn Date(MM/DD/YYYYI IFaBU,YER(S)T.6FaM PEE(S)-APPLIEMIIIQN/FQR3$RQPEEtrli A;Y4DEDUCT[QN Sill DENTiIFYE LFITEMSST:HAT?AP,PILY C71-7 l I Jeffrey A. Willis Susan N.Willis Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document 8496 E. State Road 168 8496 E. State Road 168 Address(Number and Street) Address(Number and Street) • .- Telephone Number E-mail Telephone Number THE SALES DISCLOSURE ONDITI FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THI}PROPER NO IDENTIFY CONDITION L OF THOSE THAT APPLY. ��.1��0/, ❑ ❑ 1.Will this property be the buyer's primary (71 ❑ 3.Homestead 8004'p-" residence? Provide complete address of primary ❑ © 4.Solar Energy Healing/CooliW! • !e 8372E 900 Sresidence,including county: ❑ 12 5.Wind Power Device �00j7.OR Address(Number and Street) ❑ 0 6.Hydroelectric Power Device Oakland City, IN 47660 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County o ❑ 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. 8496 E. State Road 168 Not available in all counties.) Address(Number and Street) Z1 - zo - z 3'- zoo co 0 4, t a -Co-cc p Oakland City, IN 47660 Jeffrey A.Willis&Susan N.Willis City,State ZIP Code County Primary property owner contact name E-mail ,