Homestead_Coffman INDIANA SALES DISCLOSURE FORM SDF ID: Fge 2
IlltEPARER 1 - 'n .µ t. rj y : v It 17bi 4i {- a':-Tds'tL i ii hil :- qr.
Ann Leek Escrow Officer
Preparer of the Sales Disclosure Form Title
7321 Eagle Crest Blvd., Suite A Foreman Watson Land Title, LLC
Address(Number and Street)
E-mail
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-Ei$EE[sER(S�/GRANTOR(�i��_�i ..s+i�__ .:� _- 2� ._i:.,�:5;.s-�a xzc.;vrrk....i_¢,� _.ti. .i. .�=- ^i a�t. . :�__'�.A�i _ v t�
Kendra L.Maikranz
SellerSS I-Name as appears at _veyo ce docu tl- Seller 2-Name as appears on conveyance document
l dress(Numbe a d Street) 1L '1�(/, Address(Number and Street)
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Telephone Number E-mail Telephone Number E-mail
Under penalties of perjury,) hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
an co plete as re uired by la, ,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
2
tan re of Seller / Signature of Seller
Kendra L. Maikranz `/ ._
_
Printed Name of Seller St MM/DD/YYYY) Printed Name of Seller in; I.i M/DD/mT)
i.EriS G 1 Y6F SY:=7APPLIGATID—NIP_OR)P;ROPEPTYQTAX7DED,Utti6N-S'iiIDENTIEY,fiktiLZITE i.i.rT @iv L. ,:I _''_ j
Mary N. Coffman
rsan conveyance document Buyer 2-Name as appears on conveyance documk N 0 3 2019
S'/a /1-a-14-tai PIA /4ve--
Address(Number and Street) Address(Number and Street)
. ii �-8sa.oCt _rh dm '1- 2217657
City,State,and ZIP Code City,State.and ZIP Code V SON COUNTY AUDITOR
mail Telephone Number E-mail
THE SALES ISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PRO' • . I NTIF .' • E THAT APPLY.
YES NO CONDITION YES NO CONDITION
0 1.Will this property be the buyer's primary ❑✓ 0 3. Homestead
residence? Provide complete address of primary sa;_,-- , , _"nrat.._ • - d Cooling System
residence,including county: ❑ S.Wind Power Device
S(° c -o- e'IS�,�Y- � ✓ 6.Hydroelectric Power Device
Address(Number and Street) ❑ ❑ )'
IA•L'- 5 c)+ -1-4/ 4 7L 34 6 ilk-, ❑ ❑✓ 7.Geothermal Energy Heating/Cooling Device
City,State Zl 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 ❑ ❑✓ 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: w, ease see instructions for:; -j'°
avn allcounties.)Address(Numeet) — — —one8 ( 6 CountyntaeJ
Number License/ID/Other Number