Homestead_Glockner ' INDIANA SALES DISCLOSURE FORM . SDF ID: _. _page 2
ilD^p.REPARF.RE., -- — -' 2 22c. ._ -- __:. — =' _ —i.
Ray M.Miley - Attorney No.4759-26 •
Prepare'of the Sales Disclosure Form Title
505 N.Church Street, PO Box 146 Law Office of Ray M. Druley
Address(Number and Street) Company
Fort Branch, IN 47648 812-753-4975 druleylaw(o)yahoo.com
City,State,and ZIP Code - Telephone Number E-mail
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E¢ELEER(S/GRANT,OR)_ _ -- - »_ i _ —
Carol A Blaine • •
Seller)-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
402 N Railroad Street
Address(Number and Street) Address(Number and Street) .
Fort Branch IN 47648 -
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TelephoneNumber . E-mail Telephone Number . E-mail
-- -Under penalties ofperjury,-I hereby certify that this Sales Disclosure,to the best of my knowledge and belief his true,correct
and complete as required by law,and is prepared in accordance with IC-6-1.1-5.S,"Real Property Sales Disclosure Act".
�: - •
`Signature fSele Signature of Seller
Carol A Blaine- August - 2018
. Printed Name of Seller . _ Sign Date(MM/DO/rYYY) . . Printed Name of Seller - — -Sign Date(MM%DD/YreY).•
;F-BUYEROGRANITEE(S) 'APP,LIGATION:�F,OR'PROPER1WZtAXIDEDUCTIONS-4 IDENTIFY,'ALLHTEMSI:THAT+APPL^Y—
Joseph M'Glockner Danielle M. Fenwick •-
Buyer I-Naine as appears an conveyance document Buyer 2-Name as appears on conveyance document
402 N. Railroad•Street 402 N. Railroad Street
Address(Numberand Street) 'Address(Number and Street)
ForttBranch,.IN 47648 Fort Branch, IN 47648
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t
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE Ti rpr g
YES • NO CONDITION I YES NO CONDITION B-A a
0 ❑ 1.Will this property be the buyer's primary is ❑ 3.Homestead tYl 1 S-J J D •
residence? Provide complete address of primary 4.Solar Energy Heating/ gqyq1tng�ys,e9p,
residence,including county: ❑ a �Uh 1. U`LU 10
402 N Railroad Street ❑ 0 5.Wind Power Device
Address(Number lad Street) ❑ 0 6.Hydroelectric Power D vice
Fort Branch, IN 47648 Gibson ❑ Q 7.Geothermal Energy I-I)U(tf _li evice
Ciry.State ZIP Code County rn T pi lrtl
❑ 0 2.Does the buyer have a homestead in Indiana to be ❑% 0 B.Is this propert� s� rtra ental prop�t 1
vacated for this residence? If yes,provide ❑ TA 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide cont, t information
including county: below.Please see instructs• .. •,l �'n, ation.
Not available in all counti•.
Address(Number and Street)
ac— I3-13— goa- WI- Oltoea4
City,State ZIP Code County -
Primaryproperty ownercontactname E-mail
1-