Homestead_Mason (4) • INDIANA SALES DISCLOSURE FORM • ,�,} SDF ID: 26 18 1123209 Pam
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Tyler S. Pequignot Escrow Closer
Preparer of the Sales Disclosure Form Title
375 N.Lincoln Park Title Center of Indiana,LLC
Address(Number and Street) Company
Warsaw, IN 46582 574-268-0832 tyler.pequignot@titlecenterofindiana.com
City,State,and ZIP Code Telephone Number E-mail
-*?!BELLERa(S3"'•r"„aYiu -ta 'W Atr^' t.A_ -a,W �.�s .. €+ir in im
Jerry L. Grubb Rhonda G. Grubb
Seller l-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
126 N.2nd Ave. - 126 N.2nd Ave- - '
Address(Number and Street) ' Address(Number and Street)
Oakland City, IN 47660 - Oakland City, IN 47660
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
c mple_t gwrgd bow,a spared in accordance wi IC 6-1.175,7 sal Pr p rty Sales Disclosure Act".
na 'reo `o.- Signature of Seller
Jerry L. rubb 12/11/2018 Rhonda G.Grubb 'p 12/11/2018
Printed Name of Seller Sign DateJMM/DDYYYYy Printed Name of Seller [ 1 'y1 lh n te(MH/DYYYY)
Haws , y . itws ( ' 1tp `grei z aaW i ea®.ale c�;rloK =:11sr�m;; vLfl IS' 7 A Yet :. D/r , -:-"'
des Kelly Maso
-Boyerl-lit as appears on conveyance document buyer 2-Name as appears on conveyance tent 0 201810
126 N.4th Ave.
Address(Number and Street) Address(Number and Street) / ; ,
Oakland City, IN 47660 IaLDm14<
E-mail Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I YES NO CONOm0N
ILl Cl 1.Will this property be the buyer's primary 0 3.Home;;;Thp
residence? Provide complete address of primary jflolar Energy Heating/Cooling System
residence,including county: i
126 N.2nd Ave. D 0 5.Wind Power Device
Address(CI , Ind Street1) ❑ ❑ 6.Hydroelectric Power Device
Oakland City. IN 47660 • 26 0 ® 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code Couory
❑ m 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.
29 (0' /i 4/tif /pc- I Not available in all counties.)
Address(Number and Street) j 074 -/3 - /3 _trod_ ace ./in -007
Charles Kelly Mason
,itiare/y A/ c/r1h //) CourtCountyPrimary property owner contact name E-mail
- - Number License/ID/Other Number