Homestead_Hipp INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
_D?,PPREPARER+ - . _ — -- . — _ 7----- 7 1-1
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 patti(a'�broadway-title.com
City,State,and ZIP Code Telephone Number E-mail
Xi;,- LLER YI,GRAN(TOR(SILL c —. T - I t.f--r= . --` - I
Thomas McClellan as PR for Fstate of Evelyn Joyce McClellan
Seller)-Name as appears an conveyance document Seller 2'Name as appears on conveyance document
'in .. / oj& W
Address(Number and Stree Address(Number and Street)
g Diests ti:1/4 Zi -17 64:/
E-mail Telephone Number E-mail
Under penalties of perjury,l hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and plete asquiredj�%w,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
• .--.
'Signature of Seller • Signature of Seller
McClellan Personal Representative // 3///q
Printed Name of Seller ' an Date iiiMM/DD/1''yn Printed Name of Seller Sian Date(MM/DD/nm
i BF BF RYER(Sj'/,GRAN;TEE(SI AP�PLICATcIQN(EQR.RRQPERT(Y(ITAXiDEDUGTIONSE•IDENTiIF.•YAI:L:ITEMSiTHA,'f))� rt�LW -
DanBuyer I-N miooeas Megan A Hipp um t�l
Buyer?-Name as appears on conveyance document BuyerL Name as appears on conveya datum
5052 WNumberkulu Dd 5052d W(Nulbra �� �05.C-
Address(Number and Street) Address(Number and Street) �0
Kailua, HI 96734 Kailua, HI 96734 (���1cz-
\11\�„p y9p Jkc • E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APN.YOL)
YES NO CONDITION YES NO CONDITION O\Ag0
0 ❑ 1.Wilfthis property be the buyer's primary 0 ❑ 3. Homestead
residence? Provide complete address of primary ❑ 2 4.Solar Energy Heating/Cooling System
residence,including county:
6209 S 1050 W 0 05.Wind Power Device
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Owensville,IN 47665 • Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ 2 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 ❑ 1 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)
R la-1n OS"HCO- ool . a69 -Oa►
City,State ZIP Code County
Primary property owner contact name Email
Under