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-ex:e-.f the Sales Disla/rnre Farm Title
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a4 Rate.and ZIP Code
Telephone Number E-mail
rSELLER(S)/GRANTOR(S) - .....
g 0m# gewARD AAisiN DA heew$(t D
Sella I-Name as appears on mmvesante document Seller 2-Name as appears on mnveyance document
. HWY-161 Oaf L • tIufy 1W spurt'
Addrrs(Number and Street) Address umber and Street)
DALE I
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and
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dbelief,is true,correct
and complete asrequired by law,and is prepared in accordance witt IC 6-1.1-5.5, Property Sales I�Lb sclosure Act".
S ,
nature of Seller Signature opener .
Q"p kC'\ E1/4t0 vJc , at 12--01-X17 AM clung.- RoaoA-lA Lb di-W/7
Sign Date(MN/DD/1TYY1 Printd Name of Seller Sign Date(NX/DD/YYY) -_
Printed Name of Seller -
F.BUYE' S GRANTEE S _APPLICATION.FOR PROPERTY TAX DEDUCTIONS=.IDENTIFY ALL ITEMS THAT APPLY - is
iianetne . A L4 C-AR(.w S eKtp&twrz•fER
I-Name as appears on conveyance d.- .• Buyer 2-Name as appears on conveyance document
_, na o f nAuI r AP l.0 E. npA/N sr'
Address(Number and Street) Address(Number and Street)
Telephone FS Number 1 THE CAI FS DLSCIASURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL Or THOSE THAT APPL�E li 5 Z
YES NO CONDmON YES NO CONDITION
® ❑ 1.Will this property be the buyer's primary NI ❑ 3.Homes-tea
residence? Provide complete address of primary 4.Solar Energy Hr�09g( iDgl ,SIFUDITOR
residence,including county: ❑ I1' S.Wind Power Device
Addres(Number and Stmt) ❑ to 6.Hydroelectric Power Device 9�1
❑ X 7.Geothermal Energy Healing/Cooling Device v
City,State ZIP Code County ❑ to a Is this property a residential rental property?
❑ igr 2.Does the buyer have a homestead in Indiana to be ❑ ® 9.Would you like to receive tax statements for this
vacated for this s odencd? If yes,provide vacated, property via e-mail?(Provide contact information
complete address of residence being vacated, below.Please see inductions for more information.
including county: r ./Not available in all counties)
Address(Number and Street) ELX�'B�-e"" `CIE)?�if(da TER
24 -2o
O0 • 07 7^003
mite$' 'e`(0&o, +cr-en"
County E-mail
ay,State ZIP Code primary Property owner contact name
License/ID/Other Number _ -- - - - -