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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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Britany Barnes Agent
• Preparer of the Sales Disclosure Form Title
226 W Broadway Broadway Title, Inc
Address(Number and Sweet) Company
Princeton, IN 47670 812-386-1687 britany.bti@mw.twcbc.com
City.State,and ZIP Code Telephone Number E-mail
Amy J Kelley
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1501 E Mary Lee Dr
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and ixniiplete as reqM ed by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
.11/6.1
Signature o eur Signature of Seller -
Amy J. Kelley 43 -A)—) 7
Printed Name of Seller Sian Date(MM/DWITIT) Printed Name of Seller Sian Date(104/00/Y1T1)
:F.BUYER(S)/GRANTEE(44.APPLICATION FORTROPERTY TAX,DEDUCTIONSIDENTIF 11; !tliS T . 1 .
1 --
Shelby M.Donnell
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
I c; 6 NJ 2-no fl v€ DEC 2 2 2017
qddress(Number a,nd Street) Address(Number and Street)
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDE THOSE THAT APPLY.
YES ' NO CONDITION ES . NO CONDITION
ISI D 1.Will this property be the buyer's primary 0 3. Homestead d C
residence? Provide complete address of primary D IA 4.Sogitiergy Heating/Cooling System IM"
residence,including county: 4
D 5.Wind Power Device
1501 E Mary Lee Dr 9
Address(Number and Street) D 12 6. Hydroelectric Power Device
Princeton, IN 47670 Gibson
D 12 7.Geothermal Energy Heating/Cooling Device
Ctoi,State ZIP Code County
0 12
0 IN 2.Does the buyer have a homestead in Indiana to be 8.1s this property a residential rental property?
vacated for this residence? If yes,provide 0 12 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.
N
Address(Number and Street) a (a C— a M 3 r/0 /——0 0 1' CI 39 1 :1'3
Not available in all counties.)
City.State ZIP Code County
Primary property owner contact name E-mail