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�LFe zJ tt J�Prrpun o/thy Sales Disclosure Form Title
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Add to(Number and Street
G(, 4 -it- CD go* Company
pry Eta:e,and ZIP Code
8C�19 !�7 ZcBs
7ekpha;r Nurtmber,
E-mail
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&ter t Nome as appears on eonwyv,cedocument
Seller 2-Nome as appears on rorvryurre document
& o
c E. (Ai/Awl- FILED
Address(Number andstree!) Address(Number and Street)
Teri Rnn S/, -ZN y7D'1q Sep 28 2018 ;
Telephone Number GIODON LUUNTY AUDITUR LB E c. ,al i
Jnder penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
Ind complete as required by law,and Is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". I
Signature of Seller
S(Tnoture of Seller
f> Ts eat ey lat/abr2
Printed Nome of Sell •er Si dn Dote(NN/aontn) PrtnKQ Nome of Seller
BUYER Date(N
6 NO CONDITION YESNO CONDITION i
& ❑ 1.Will this property be the buyer's primary €1..„ 0 3.Homestead I
residence? Provide complete address of primary •
residence,including county: 0 ❑ 4.Solar Energy Heating/Cooling System
Doc E. tve-d v)y f 5 J. ❑ IZI 5.Wind Power Device
Addess(Num der and Street) ❑ (j, 6.Hydroelectric Power Device
Fee?-th7o6b , s/t/ H7'M$ 6,4va1
Dry,Store ZIP Code Gary ❑ /❑ 7.Geothermal Energy Heatlng/CoolingDevice
s
3 f❑ 2.Does the buyer have a homestead in Indiana to be ❑ ❑ Is this property a residential rental property?
vacated for this residence? If yes,provide 0 9 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(Nivebe,aril Street)
City,bTa:e ZIP Code 26-19-18- 304-000 . 416-026
•
County
Primary property owner contact name