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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER - - - •_ -.- . _ - - _
`- C h , Wil riSiS1 Escrow Officer
heparer of the Soles Disclosure Fan, Tide
800 Lily Creek Road, Suite 102 Freibert & Mattingly Title Group, LLC
Address(Number and Street) Company
Louisville. KY 40243 502-238-7500
City,Rate,cad Zi?Code Telephone Number E-mall
E.SELLE1(R,(S7GRANTOR(S) . , _ ;: ?/ l^' '_
/ /10. qs Leh fl, etc,/ \)I /WJ-�/ n I / , �1'-'.l`^� pas
Seller I-Name as appears on conveyance document Sellerz•Nameolrfappearsan conveyance document
.33C/ F. Cheasy s-I _ 33o C.Antr ,S-rv-e-. -
d4dr (Na ber and Street) Addrea Number and Street) ,
Kland 0,-1 in `]ltlO
Under penalties o perjury,I hereby certify that this Sales Disclosure.to the best of my knowledge and belief,is true,correct
and p ete s u' ed by law and is pared in accordance with IC 6-1.1-5.5."Real PropertySales Disclosure Act".n
Signaturet a(Seller Signature ofSeaeC
ffl:i k, Ire tit /A'(Tut to/cd/J4j? Shato.or, ill . Pi er._.e._ P/Ca/or/i
Panted Name ngSeaa Sian Dacu/Ofr1Y1] Primed Name d75eiier Sian Date Om/Do/my)
F.BUYER(SJ/GRANTEEsSp_-APPLI - TION:FOR:PROP,ERTY:TAX.DEDUCTIONS-IDENTIFY:ALLITEMSTHATAPPLY
lLa SS W gla-1
Boyer l-Mane as appears anon nce document Buyer 2-Name as appears an conveyance document
/ rxq- F /4ILI Pam.
Address(Number and Street) Address(Number and Street)
s THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR MIS PROPERTY.IDENTIFY ALL OF THOSE T.
YES( NO CONDITION YES NO CONDITION
,.u_/ ❑ 1.Will this property be the buyer's primary ❑ Er 3.Homestead q�f qq�p��
residence? Provide complete address of primary ❑ 4.Solar Energy Heating) in®sTysfcMia
residence,including county: ❑
5.Wind Power Device
Address(Number and Street) ❑ 6.Hydroelectric Power Del e • '��1101:
�I . R
co;State IF Cade County CI 7 eothermal EnergyHfe�`:I t_• : Vs TO
0 91 2.Does the buyer have a homestead in Indiana to be 0 8.Is this property Mffential 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.)ire) (l I//I
Address(Number and Street) arc - I 1 -I -�o3 -s/V I . l (���(y�,Jy�/�l
City.So,te ZIP Code County '- '
Primary property owner contact name E-mail