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Homestead_Leister •
• INDIANA-SALES DISCLOSURE FORM. .
yEMPREPARERi_ _ a _ -- _ — - — • - ,' -^---r .,';' _ -
'Ray M DrUlev _ - Attorney No.4759 26-.. . • -
. `Preporer of the Sales Disclosure Form - Title - - - -
' 505.N:.Ctuicli.'street:PO Box 146 Law.Office of.Ray M. Diillev
Addreis(A'uinbeiand StieetJ Company" --
- . ' '
I Foit.B�anch;IN�47648•
812,753-4975 I druleyla v yahoo.com
City?State;and ZIP Code I , • Telephone Number I ';:E-mail: - .
. lE'::SELI ERiS)/GRANT01f* 7.. L- ^ ' "-a1z-�,-�- -5 . :r., - .'i ' .. : , .*-...1:-^.-
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e.c4i-2
-
• David L Patterson
selliFi Nome as appears on conveyance document Sellerg-Name as appears on conveyance document
' 85467Mahchester Ct- .
Aadiess(Numbe'rand Street) Address(Number andsti-eet)
Evansdilje'IN 47725 .
City Stote,and ZIP Cade- I City,State and ZIP Code I
perjury,I hereby.certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
andcoinpletc as r eggircd by la}y,"and is prepared in accordance_With IC6-1.1-5.5,"'RealProoeit Sales Disclosure Act".
. Signature of Sellir Signature of Seller , .
flavid I.'Patterson March 11 2019 .
..Printed A'ame of Seller .. ... . Siqn Date(MM/DD/YYYY) - 'Printed Naive of Seller .. . +..•.Sian Date(MH/DoryYY1). .
IT.,BUYERf TGRANITEE . 'APP:EIGATIONtEORteROP,ERULTTAXIDED.UG-TIONSbIDENTIFY/AL omEMSLTHATAPPRYi °'�---
:ScottLei tet ' ' -. " ,•... .. .. _- t -f 7..
Buyerl Aame as appears on conveyance document Buyer? Name as appears on conveyance document
— 203E John Street
Address(Numbetand Street) . • Address(Number and Street)
Fort Branch,.
E-mail Tel ephone.Number - ' 1. :.(a'/ �ZO
THE SALES DISCLOSURE FORM MAYBE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF TROSE THAT •
YES. .NO CONDITION I YES NO CONDITION. t COG •
ID '❑. 1.Will this property be the buyer's primary ❑✓-' ' n 3 Homestead •
residence? Provide complete address of primary ❑ n 4 Solar,Energy Heating/Cooling Sys$ ,<•
residence,including county. t' .0,9 ,
203 E Joli'n�Street' ❑ ❑✓ 5.Wind,Power Device
Address(Number and Street) ❑ ❑✓ 6.Hydroelectric Power Device
Fort Branch, IN 47648 Gibson ❑ `❑✓ 7.Geothermal Energy Heating/Cooling Device
City.State ZIP Code County
•
❑ " 22. Does the buyer have a homestead in Indiana to be ❑ ❑� 8.Is[his property a residential rental property?
""vacated for this r-Aidence L m
e If yes,provide ❑ f 9.'Would you,.ice 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 availdbleiri all counties.) '
Address(Number and Street)ZIP •
Code �;nr/ �- /!/
City.StateCounty N(Y - /j
/" /J_ " d- off . J90 - Da?6. .
Primary property owner contact name __ _ ��,.- -_ ,E-mail
Number License/ID/Other Number
