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Nae as ears conveyance `PP on eymnce docv ent Sellerl Name as appears on conveyance document 3-Yc, f 12Ia1 ev- 4�Y-/2
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Address(Number and Street)
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Signature of Seller
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SALESDISCLOSURE FORM MAYBE USED TO APPLY FORCERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY- - mail
YES -.NO CONDITION -
;. NO CONDITION
❑ 1 Will�this property be the buyer's primary [►/�0 3 Homestead
I residence? Provide complete address of primary
0 4.Solar Energy Heating/Cooling System
residence,including county:
0 E ' 5.Wind Power Device
Address(Number and Street)
0 ✓[,f 6.Hydroelectric Power Device
CIry,Smte II Cdde ry ❑ V- 7.Geothermal Energy.Headng/Cooling Device
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0 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 Ur 9.Would you like to receive fax 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.
Nat available in all counties.)
Address(Number and Street) „
Ciry,Srate ZIP Code A6-Cl2Sti '' O. Z ��0O '24 1 ^.019 ..
['wino, ., . L"1 l _I
Primary property owner contact name -