Homestead_Marsh INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER
Britany N Barnes Agent
Preparer of the Sales Disclosure Form Title
226 W Broadway Broadway Title, Inc
Address(Number and Street) Company
Princeton, IN 47670
mail
E.SELLER(S)/GRANTOR(S)
Samantha Shoultz
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
821 N Main St
Address(Number and Street) .Address(Number and Street)
Oakland City, IN 47660
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
aqd complete ass r equ rgd by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller`-f,F-iX-/1/� Signature of Seller
Samantha Shoultz 5/(y/i
Printed Name of Seller Sian Date(NA/Do/YIYYI Printed Name of Seller Sian Date(MN/DD/}lTY)
YER(S)/GR.4 E(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT(�eLY
Cody Ray Marsh ag�' �9YJ�p
P - ���•••,on cconverenee document gayer 2-\'orne as appears iemnv on
710 E Washington St
Address(Number and Street) Address(Number and Street) MAY 1 6 2019
Wheatland, IN 47597
'
E-mail Telephone Number Gig JOuueu/ouTN'T"°v�`AUDITOR E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY AI L OF THOSE THAT APPLY.
YES NO CONDITION ES NO CONDITION
❑ 1.Will this property be the buyer's primary ❑✓ ❑ 3.Homestead
residence? Provide complete address of primary ing/Cooling System
residence,including county: ❑ ❑✓ 5.Wind Power Device
821 N Main St
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Oakland City. IN 47660 ❑ ❑✓ 7.Geothermal Energy Heating/Cooling Device
City,state P Code County ❑ Q 8 Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes,provide ❑ ID 9.Would you like to receive tax statements for this
complete address of residence being vacated, rty via e-mail?( rov act information
including county: below. Please see instructions for more rmation.
Not available in all counties.)
Address(Number and Street)
City,State ZIP Code Coun_ —14-18 -2-01 -000.968 -0 ' •
Primary property owner contact name
-mail
•
Number License/ID/Other Number