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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
nDSP,REFARER— —i�--- w f r.' - �_- i. t , i _7 - - -- .---r- -
Steven L.Whitehead Attorney
Preparer of the Sales Disclosure Form is Title
111 N. Hart Street
Address(Number and Street) Company
Princeton, IN 47670 812-386-5040 whiteroc2(o'�gmail.com
City.State,and ZIP Code Telephone Number E-mail
!•Ei•SEECER( I'/,GRANTOR(Sj _- . ..a 7 _. 7.f` i ..a ,..c a '�,. _ ... .72.., -T. .
Estate of Kenneth R Lackey
Seller 1-Name as appears on conveyancedocument Seller 2-Name as appears on conveyance document
429 W Glendale Street
Address(Number and Street) Address(Number and Street)
Under penalties of perjury,thereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete as re fired b .law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
SignatureIaf5eller /( / - Signature of Seller
•
- Rloncenie 1 arkey Personal Representative _
Printed Name ofSeller "A Sign Date(FtM/DD/1YYY) Printed Name o(Seller 1 [SicDate(MM/ODiYYYY)
i_eiBUIYER(S)/.ERANTEE(S)?MAPPLICATIORTAR?P,ROP:ERTOITAX<DEDUGTIQNSLIDENTIEVAII t E S�%H FL r :=
Blonie Lackey
Buyer l-Name as appears on conveyance document Buyer 2-Name as appears on conveyantu'ti4qure�nt 2010
429 W.Glendale Street IVU Y / C U
Address(Number and Street) - Address(Number and Street) f�
Patoka. Indiana 47666 `
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
❑✓ II 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary n 0 4.Solar Energy Heating/Cooling System
residence,including county:
❑ ❑✓ S.Wind Power Device
Address(Number and Street) ❑ ❑✓ 6.Hydroelectric Power Device
Gibson ❑ E 7.Geothermal Energy Heating/Cooling Device
City State ZIP Code '`• County
❑ Q 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 ❑ ❑✓ 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) v
ao - 12.-01- 1D1-00( ,oia-bag
City.State ZIP Code - County
Primary property owner contact name E-mail