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Homestead_McCoy (5)
INDIANA SALES DISCLOSURE FORM SDF ID: - Page 2 `_D.tEPARER' -_ : _ _ • -- --- - - -- --j Patti Kolb Closing Manager Preparer of the Sales Disclosure Form Title 226 W Broadway St Broadway Title, Inc. Address(Number and Street) Company Princeton. IN 47670 812-386-1687 oatti@broadway-title.com City,State,and ZIP Code Telephone Number E-mail E(.SEL ER(fhatANTiOR(S), -ir n-, Dorothy Koherstein Trust(Dorothy Koherstein &Teresa Dove TR - - __- Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document 214 S Stormont St Address(Number and Street) Address(Number and Street) Princeton IN 47670 E-mail Telephone Number E-mail Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete as required by law,and is prepared in accordance ' I -1.1-5.5 ' eal Property Sales Disclosure Act". llet la 10i � �� P Signature o/Seller 'Signature a/Seller Dorothy M erstein Teresa Dove = ' Printed Name of Seller Sian Date(MM/OD/YYn) Printed Name of Seller Sian Date(HM/DD/YY111 TF:,BU-Y:ER(S)'/,GRANTEE(Sji AP.YE ATION FORSPROPERTeY AVDEDUCTIONS_IDENrTIFWALLYTEMS�THATAPP y II Shannon Denise McCoy -e- I . P Buyer 1-Name as appears on conveyance document Buyer Z-Name as appears on con eee ocr ent - 404 W Pine St. I- .a Address(Number and Street) Address(Number and Street) - \-•j,U(" Princeton, IN 47670 C\FC 3 City, E-mail Telephone Number .4l6 siA( ' E-mail THE SALES DISCLOSURE FORM MAY HE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAAMITLY(� YES NO CONDITION YES NO CONDITION ``.° EZI ❑ 1.Will this property be the buyer's primary Q ❑ 3. Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: 404 W Pine St ❑ ❑✓ 5.Wind Power Device Address(Number and Street) ❑ M 6. Hydroelectric Power Device I Princeton. IN 47670 Gibson ❑ Z 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ ( 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 ❑ IA 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) OW- 1.— Q9— tof — (Col. o\o- oag. City.State ZIP Code County Primary property owner contact name E-mail Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".(Note: Spouse information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is beit Number License/1D/Other Number