Homestead_Dix INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPKI2ER- .. '-'7 I
_. _ --,itir17,1G n i`'-';Y_, I_. • __ s-Y-'I Y. _-- 11 __i.;C_-2iijl aY.7- {
Leon C Stone President
Preparer of the Sales Disclosure Form Title
226 W Broadway St Broadway Title Inc.
Address(Number and Street) Company
Princeton, IN 47670
City,State,and ZIP Code Telephone Number E-mail
:E..SelfEKST16k ANTOR(S __i_ '. r_i. .-M ._-ate'4:� Y �--_•��it S a_.-_-42;r...".a_t.�t..7+ . .r_•._F__:_L r....ii.•_1. it .r : sMvr f
Betty Gwaltney In tstee& individually
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
704 E Walnut St
Address(Number and Street) Address(Number and Street)
_EC/LBfanch IN 47648
City.State,and ZIP Code City,State,and ZIP Code
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, nd is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
•
Signature of Se •r Signature of Seller
Betty Gwaltney --^ 13-jojq _
Printed Name of Seller Sian Date tMM/DD/IYY11 Printed Name of Seller Sian Date OLM/DO/111 it
'F.QU -ER(5}/ 2ANTEE(S)_APPL[CATION.FOR;PROPERTY TAX'IDED.UCTIONS IDENTIE,Y ALL•1•T 3• 7$f A t '- _f
Herbert Dix Maureen Dix
a 6pears on conveance document Buyer 2 Name as appears on conveyance document
631E 750 S 631E 750 S ti Nv1Q
Address(Number and Street) Address(Number and Street)
Fort Branch, IN 47648 Fort Branch. IN 47648 ---
E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS P PRE Tl'. IDENTIFY A LLOF TH HAT APPLY.
YES NO CONDITION YES NO CONDITION
Z ❑ 1.Will this property be the buyer's primary ❑ 3.Homestead
residence? Provide complete address of primary eating/Cooling System
residence,including county: ❑ ❑
704 F WalnuLSt 5.Wind Power Device
Address(Number and Street) ❑ Z 6. Hydroelectric Power Device
Fort Branch, IN 47648 Gibson ❑ 0 7. Geothermal Energy Heating/Cooling Device
City.State ZIP Code County
IZ ❑ 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 ❑ CZJ 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: b w Wenstseeirtshictte r more information.
E.Werliiut St 3( . 7So • Not available in all counties.)
Address(Number and Street) ^ f� �[�� / ^IA _1� So Lk �O • .. ^02 n
} F .1"�Y d�� Gibson /V_ (-a\` /K7�
City,State ZIP Code County
Primary property owner contort name F-