HomeMy WebLinkAboutHomestead_Rasor i . INDIANA SALES DISCLOSURE FORM SDF ID: Page 2'
D.P.REPARER - -
Cheryl Russell Title Escrow Officer
' Preparer of the Sales Disclosure Form Title
1532 Wabash Avenue Integrity Title Services
Address(Number and Street) Company
Terre Haute, IN 47807
LLERfS�/GRANTOR(S)E�.S - "
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Seller I-Name as appea rs on eyance docs ens Seller l-Name asa
7P/ g cony VAC"
Y,/[(n ,� appears on conveyancedo document
Address(Number and Street) Address(Number and Street)
T EF srJ L-1- '1 S 0 i
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 completeA as r�.apa-sired by la , is prepared in accordance with IC Fir . s. 31v1 Pr pe Sales Disclosure Act.
l Si n' ttyi ,kllL_}k' A 5-in 2-jN f(1 P 7-11 O R S(q (wk of Seller vta[ J,ghf a�
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PrintedMauSeo(Sdeler �� ��� ,,,y,wte IMM/DD/nYlt Printed Name of Seller a te(MM/DD/YYYY)
F.BUYER(SI/GRANTEE(S -'APPLICATION FORPROPERTY TA3�" C79T71 •''IIIENTIFY•pI C n``" -
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Buyerl-Name as appeaa anotwayfinte comment Buyer 2-Name as appears on conveyan¢
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A Number and Street) Address(Number and Street)
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CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
ES NO CONDITION YE ' NO CONDITION
❑ 1.Will this property be the buyer's primary V I ❑ 3.Homestead .�"
/ residence? Provide complete address of primary ❑ Al 4.Solar Energy Heating/Cooling System ='
residence,including county: ❑ Er5.Wind Power Device
130 w 31o3 •
Addre5��NNumber and Street) _�" ❑ 7❑ ji.Hydroelectric Power Device
C ( ocetoK Sl1 y16-ID lv3D11 L,,/
I .Geothermal Energy Heating/Cooling Device
city,Stge7lPCode
❑ I1I, 2.Does the buyer have a homestead in Indiana to be ❑ �8.Is this property a residential rental property?
to be
vacated for this residence? If yes,provide ❑ - 5 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.
Not available in all counties)
Address(Number and Street)
d 4- /a . .30 -300 -00/. S'o.3 -0.22
Ciry,State ZIP Code County
Primary property owner contact name E-mail
Number License/ID/Other Number