Homestead_Frederick (5) INDIANA SALES DISCLOSURE FORM SDF ID: - - Page 2
DI,p,REP,A ERER R-_- - - - . • - - -
Leon C. Stone President
Preporer of the Sales Disclosure Form Title
226 West Broadway Street Broadway Title, Inc.
Address(Number and Street) Company
Princeton. IN 47670 (812)386-1687
City,State,and ZIP Code I Telephone Number I E-mail
I
LeiselLER(S)/GRANTORM --- ---- - - -- _ - , -_-- . _--.-_-
Daniel S Mendoza
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
L1I L1 / Oa ski n 5/,
Address(Number and Street) �J Address(Number and Street)
Nun-Li*?buy_ 1/U (17SLIM
M�('
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
anI omplete as re ired bya�w,and.is prepared in accordance with IC 6-1,1-5.5,"Real Property Sales Disclosure Act".
Signature al Seller S(/ Kern/ U �i �j Signature of Seller
faniel S Mendoza 3 U - i -I
Printed Name of Seller Sian Date(MM/OD/YYY) Printed Name of Seller Sian Date(MM/o0/rvv)
I F!-BLKERjSJ' NITHE(S FAP.P-Il CATIONIEORAM RERTtYLTAX?DEDUCTIONS`ID.ENTIFY(ALB hTIEMSiT.HATiAPPLV( 1
Ra
ymond S. Frederick Rebecca S. Frederick
Buyer I-Name as appear on con ce document Buyer 1.Name as appears on conveyance document
611 olk Street 611 Polk Street
Address(Number and Street) Address(Number and Street)
Oakland City, IN 47660 - Oakland Giy,-IN47660 _
Telephone Number E-mail Telephone Number E-mail
• THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS P ERTY.-IDENTJFY-ALLOF--THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
Q ❑ 1.Will this property be the buyer's primary Z. ❑ 3.Homestead
residence? Provide complete address of primary 4.Solar Energy Heating/Cooling System
residence,including county:
123 W Dale Street D ❑✓ S.Wind Power Device
Address(Number and Street) ❑ IZl 6.Hydroelectric Power Device
Oakland City, IN 47660 Gibson ❑ El 7.Geothermal Energy Heating/Cooling Device
- City,State ZIP Code County
❑ 0 2.Does the buyer -. ( .. st- : ' •na to be ID 0 8.Is this property a residential rental property?
vacated for this r:1:•I e L If y ,rt. ❑ 0 9.Would you like to receive tax statements for this
complete addres-of f r-( -•Uhief: ted, property via e-mail?(Provide contact information
including county: ow. lease see instructi(msf more information.
MAR 11 2019 Not available in all counties.)
Address(Number and Street)
/ 2 $-14-1 - 3o1\ - 00 ) . c0fi� --oo3-
Ciry,State ZlPCode `"� Co my < •
_
`\ Primary property ownercontact name oil