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Homestead_Brummett I
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
LANA C. HARPER CLOSER
Preparer of the Sales Disclosure Form Title
5231 Oak Grove Rd.. Ste.A TOTAL TITLE SERVICES, LLC
Addres(Number and Street) Company
EVAN7CVILLE. IN 47715
Email
ESELLER(S)/GRANTWk(S) _ -- ' .
Sue Fll°n Bpleat
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
9o7 61/L<50AJ A%)f/
Addres1(Number and Street) Adelress(Number and Street)
icZ.in)Ce--o PJ ) I y7lo70
City,.Stale,and
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 as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
aeo/Lt ELn 1,0 6lio CAL
SUp3uture of Seller .L� 2 Signature of Seller
Sup Filen Reloat / J /9
Printed Name of Seller Sian Date Les:/UD/fn) Printed Name of Seller Sian Date DDt/aa/iTYI)
'F BUYI R(S)%GRANTEE(S)'-_''APPLICATION;F,ORiPROPERTaYTAX'DEDUCTIONS_IDENTII Ya1T I'ITEMS,THAT-AppLl ,, L ' -°'
aura - Brummett \ ��p� ��� ED^
OK1" � ^n �J,'nveynnredrcwnent Qvyer2"A'omeasaplxarsanronveyan�u�•r�
0 .72r& /&w
Aim,.a(Nu bar and Street) Address(Number and Street)
I' �l N �{7(c�� APRs 7019
City,
E-mail Telephone Number E-mail
TIIE SALES DISCLOSUREFo RM MAY BE USED TO APPLY raft CERTAIN DEDUCTIONS FOR TIIIS PROPERTY. IDENTIFY ALL OF THO$E 1 'P�bUNTY AUDITOR
YES
, ,NO CONDITION I .5 NO CONDITION
W bI
❑ I.Neill this property be the buyer's primary 12- ❑ 3. Homestead
/_Q residence? Provide completeco address of primary u -+.Sum toriby eating/Cooling System
6 90 Ssic(eLCPt)a u1i t}gr"C1le:Ta L ❑ ❑✓ S.Wind Power Device
py.Jress(timber/r,�ysvoet) Al ' r ❑ 17 6. Hydroelectric Power Device
' `�/� '✓r��C/� �' " 7��� " /`'�501
❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ ❑/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 ❑ 1Z 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 snore information.
• al a le in all counties.)
Address(Number and Street) (y� 1 /e�
City State ZIP Code county C l0 - ` - aot� .0o0 . 55.0 - oar
" p-T+•+•-^r.n.^-r ,er °mart name E-mail
Number License/ID/Other Number