Homestead_Ashley INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
(DPREPARERr .' - - 117-4'- L 7...71g ,k t }k- ---CJ-i 577-7, T.: - ..
Omer Ash (ey
Preparer of the Sales Disclosure Form Tide
Address(Number and Street)
E-mail
OAkiar) L i�-y.�Y /776 0
°
FE:$ELER[S //GRA7Cf s) w 1 `I a a- -»: .6. _�iF >b u-;•re __'_1?7� d_• P `: tr: a:_ _tz..:._ .
4
of ey;ns /-/c/ts
Seller I• a as appears on conveyance doormen Seller 2-Name as appears on conveyance document
C351 A,vic;ansF
dress(Number and Street) Address(Number and Street)
GK 16 ll d (I fy, I, -N7C6'D
E-mail Telephone Number E-mail
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and com lete7s required by law,and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
6
Signs of Seiler z 1 Signature of Seller
AI/Oty(Bleri ns) #e/tc/c t�
Printed Name f rt ler Sign Date(MM/DDAYM Printed Name of Seller SCgn Date(UM/DDMYY)
inU-Y.FFOI NTEE(S):-AP:$ Al't0{+J..PROPERTYrTAX-DEDUCTIONS-,IDENT,IF,YKLL,ITElvS.THATAPPLY _` ,-, I
_041 er A: p 4k /eV
ey-er]-Nameas appears on conveyance document Buyer 2-Name as appears on conveyance doc eat
Address(Number and Street) Address(Number and Street) MAY 1 0 2019
r/4f , madii _10 '7 5f
City,State,and ZIP Code ` City,State,and ZIP Code n
Telephone Number .,, E-mail Telephone Number CIRSnnI E-mail
cetfrlr, �1_
"..... tE?BtS taSitREpOR31�$P.EE-USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDEN LL OF THOSE THAT APPLY.
YEj NO CONDITION NO .CONDITION—.
s ❑ 1.Will this property be the buyer's primary Homestead
residence? Provide complete address of primary 4.solar Energy Heating/Cooling System
residence,including county: ❑ rer5 Wind Power Device
Address(Number and Street) ❑ Hydroelectric Power Device
❑ 7.Geothermal Energy Heating/Cooling Device
City,Sta�teZ de County
❑ Nil 2. Does the buyer have a homestead in Indiana to be ❑ $ Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ Er 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.
IV rnvuila-bfei I counties.
Address(Number and Street)
2 a- 13-729 - 1,01- 000 - 219-pc,
City,State ZIPCode County
Jimmy property owner contact name £-mai
Number Number License/ID/Other Number