Homestead_Breeden INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
;D. P.REFARER -
Britany N Barnes Agent -- -
Preparer of the Sales Disclosure Form Title
226 W Broadway Broadway Title, Inc
Address(Number and Street) Company
Princeton, IN 476701 812-386-1687 IBritany@Broadway-Title.com
City,State,and ZIP Code ' Telephone Number E-mail
I
E.SELLER(S)/GRANTOR(S)
Noah Velthouse Paige Velthouse
Seller I-Name as appears on conveyance document Seller 2-,Name as appears on conveyance document
310S Hart St 310SHart St
Address(Number and Street) Address(Number and Street)
Princeton, IN 476701 Princeton, IN 47670
City,State.and ZIP Code
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� r q fired by law,and is prepared in accordance wit IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
l
Signature of Seller .I ignatu. of Seller Noah Velthouse 02.Z7. 2oI5 Paige Velthouse
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4
Panted Name of Seller Sian Date(FIM/OD/YYn7 Printed Name of Seller yS Date(MH/OD/nTY)
FaBUYER(S)/GRANTEE(S)-APPLICATION FOR.PROPERTY TAX DEDUCTIONS-IDENTIFYALLIT, 'HAT PPJILr, - . '
Donnie E Breeden
Ch
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conve ,nce acumen( b
' 6 C) - s5. o
Address(Number and Street) Address(Number and Street)
Pr.afre110 7p'U V -2G-76 �Jo\jO
E-mail Telephone Number �$ E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FUR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE Tf T APPLY.
YES NO CONDITION YES NO CONDITION
❑✓ ❑ 1.Will this property be the buyer's primary g ❑ 3.Homestead
residence? Provide complete address of primary ❑ ❑/ 4.Solar Energy Heating/Cooling System
residence,including county: ❑
310 S Hart St r-,� 5.Wind Power Device -
Address(Numherand Street) ❑ LJ 6.Hydroelectric Power Device
Princeton, IN 47670
❑ [fj 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ ( 2.Does the buyer have a homestead in Indiana to be ❑ d 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ vi 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)
aLt — ID, -07- :sO D -00 (. '1u9 -0as.
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
Last 5 digits of Buyer 2/Spouse Driver's State Last 5 Digits of Social Security
License/ID/Other Number Number License/ID/Other Number