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Homestead_Jones (20) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D.PREPARER Leon C. Stone President Preparer of the Sales Disclosure Form Title 226 West Broadway Street Broadway Title, Inc. Address(Number and Street) Company Princeton, IN 47670 (812)386-1687 bti( mw.twcbc.com City,State,and LP Code Telephone Number E-mail E.SELLER(S)/GRANTOR(S) ° . Michael R Hersel Seller 1-Name as appars on conveyance document Seller 2-Name as appears on conveyance document 412 W Emerson Street 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 complete as red by law,an, is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". Signature of Seller .!(YY1I ,/ / Signature of Seller Michael Name Hemel USi /a9 4 Printed Name of Seller SigdddDatel /Dateml Printed Name of Seller 1r" (on Date(MM/DOITEM F.BUYER(S)/GRANTEE(S) -APPI:ICATION.FOR PROPERTY TAX DEDUCTIONS-IDENTIFY A LI TEM THATP-IP' —..".r 4aJ -mi. u.ri- •n- - • ,.pears an conveyance document Buyer 2-Name as appears on conveypgggtt]]doytn(�nt2GIs 412 W Emerson Street FFii UU 11 $$ Address(Number and Street) Address(Number and Street) Princeton, IN 47670 � �� � YES NO CONDITION YES Q ❑ 1.Will this property be the buyer's primary Q ❑ 3.Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: 412 W Emerson Street 111 frl 5.Wind Power Device Address(Number and Street) ❑ Q 6.Hydroelectric Power Device Princeton, IN 47670 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ Z 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) a(e -/4 - b7 _ /03 - oo3. S 78-O )-8 City,State ZIP Code County Primary property owner contact name E-mail