Homestead_Young (12) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
`DaP,RE$ARER - e r -. ---7-- -- --F---7— --- z ` --rmL- '
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 btii mw.twcbc.com
City,State,and ZIP Code Telephone Number E-mail
ETSELL'ER(S)'/,GRANrTOR(S). -`
°bed Stanley Church Judith Kay Church
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
12128 East Hickory Lane 12128 East Hickory I ane
Address(Number and Street) Address(Number and Street)
Oakland City IN 47660 Oakland City IN 47660
mail
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and completeas eguiutredby law and is prepared in accordance 'th IC 6-1.1-5.5,"Real Property Sal Disclosure Act".
SC �[� �LI G� / �2UJ YVfSC� Q C� U� •
Signature of Seller / �j nature of Seller
`/
Ohed Stanley Church i /f o/?�f 8 Judith Kay Church /9//0/�d I
Printed Name of Seller Sian Date(MM/DD/I I rr) Printed Name of Seller Sion Date(M.N/DDaYYI) '
;P.,ITI.Y6RE ' -- TEES) ABPLTEA•TIONIEOR;PROP:EMIY,TAXDEED�J -T.—le'S=11:78N'FIEYAEEJTiEMSITHATcAPPLY .
(---Charles P Young 7 Kimbedv K. Youn9
on conveyance document B - on eonveyanpg.-"'1a"r� E�\
12124 East Hickory Lane 12124 East Hickory
Street)Lane J�, ` pg/�fJt
Address(Number and Street) and
Oakland City, IN 47660 Oakland City. IN 47660
E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPER]y_[DE FiF-' SE TH IF •
YES NO CONDITION _.Y NO CONDITION GGIBSO OUNTY AUDITOR
❑ ❑ 1.Will this property be the buyer's primary < 0 ❑ 3.Homestead j
residence? Provide complete address of primary l�Ct .(- 'tm>'Ey_„eating/Cooling System
residence,including county:
12128 East Hickory Lane ❑ ❑✓ S.Wind Power Device
Address(Number and Street) ❑ Q 6.Hydroelectric Power Device
Oakland City. IN 47660 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
171 ❑ 2.Does the buyer have a homestead in Indiana to be ❑ 6.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ WI 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.
12124 East Hickory Lane Not available in all counties.)
Address(Number and Street)
Oakland City, IN 47660 Gibson °dCr^ 1 —
1(] _1 1 l_l 203-o0D. 0 i g -00 .
City,State ZIP Code County
Primary property owner contact name E-mail