Homestead_Prill INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
_DSPREPARER+ - - --?,r,> --- "---_-� _,. _ _. - 7-1 i�f': _ _"i
Leon C. Stone President
Preparer of the Sales Disclosure Form Title
226 West Broadway Street Broadway Title, Inc.
Address(Number and Street) Company
Princeton, IN 47670 I (812)386-1687 I
City,State,and ZIP Code I Telephone Number I E-mail
7— ..
LE:;SELIER(S)�/GRA— NrT,OR(S)P.. - --. - -7,..—,•-_7-7 „_; 47. _,-'...
Wiliam Charles Atkins Jana Michelle Atkins
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
10263E 450 S 10263E 450 S
Address(Number and Street) I Address(Number and Street)
Under penalties of perjury,t hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete a regmr d by I w,a d is repared in accordance wit C 6-1.1-5. Real Pro erty S les, isclosure t".
P.
Signature of Seller Signature of Seller �17�
William Charles Atkins OA7/•2O/9 Jana Michelle Atkins 03 Z��lY1 M
Printed Name of Seller Sian AAAAate(MA�/DD/YYYY) Printed Name of Seller Sian Date(M.x/DO/YYYY) I
, ; 1\TEE(S)i AP LICATIONIEWITIIGPERTIYLTAX?DERUCTIONSEilDENaT1EY(rliiIIIMBITHAVAHREYn -c -`�-
Michael D. Prill dr i IY-1 R E]
•rs on conveyance document Buyer 2-Name as appears an conveyanced me �JL J��
123 W 1st St Address(Number and Street) Address(Number and Street) APR 2 2019
, ,t
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION ES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of prima --gy Heating/Cooling System
residence,including county: ❑ ❑
11443E 50 N 5.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Oakland City. IN 47660 ❑ 0 7.Geothermal Energy Heating/Cooling Device
City State ZIP Code County
171
❑ 0 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 ❑ Z 9.Would you like to receive tax statements for this
complete address of residence being vacated, ore•• --• •'. •- . : . contact information
including county: below. Please see instructions for . , 'n ormation.
Not available in all counties.)
Address(Number and Street) 4 3-� 03\ `, 1 AL_O .� �•
6�1 2-2�0-1.1�-J t{. IvVO
City,State ZIP Code County
. •ro•-•• ontact name E-mar