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Homestead_Jolly INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 ,D PRETARERs _ . _ - .77: .'"- __ __ .___ ... `— r`F-... —._>—T —.r:aa._ Kim Minkler Owner Preparer of the Sales Disclosure Form Title 2164 E Dead Level Rd Address(Number and Street) Company Hazleton, IN 47640 _812-779-6205 City,State,and ZIP Code Telephone Number E-mail linEI:LEk(S)'/.GRAN.0R(SJ`: -'�•4X_,1 a,7-iii/1 i='�i,`c.l__11-' aaa;dli' ha irci-i7r;v `i viC-•.IS' .9'•-1`eJt—r= ,•-s^^yr=5t ti; Wayne A Minkler Kimberly D Minkler Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 2164 E Dead Level Rd 2164E Dead Level Rd Address(Number and Street) Address(Number and Street) Hazleton IN 47640 Hazleton IN 47640 City,State,and ZIP Code City,State,and ZIP Code 812-779-6185 812-779-6205 Telephone Number E-mail Telephone Number Email Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct a complete s r urr,e by law,and is prepared in accordance withS 6- 1-5 5,"Real Property Soles isclosure Act". , �u� Si alareo 'el'_r Signature of Seller 2It/1/ A Wayne A Minkler Kimberly D Minkler Printed Name of Seller Sian Date(MM/00/l r rp Printed Name of Seller Sian Date(MM/Uo/IYYY( P..BUYER(S)`/GRANTEE(S)1�APPLICATION-?F'ORTPROPERTY_TAXsDEDUGTIONS,iIDENTIFWALEITEMS$ -7 EYt_ _ Michael C Jolly Karen M Jolly q /��' Buyer l-Name as appears on conveyance document Buyer 2-Name as appears on conveyance doe nt 611 E Center St 611 E Center St �( ,A{ 2019 Address(Number and Street) Address(Number and Street) JUN Y 0 Hazleton, IN 47640 Hazleton, IN 47640 - City,State,and ZIP Code City,State,and ZIP Code • I it 812-779-7659 — -"Wmm-e_ - .r •C Tele hone Number E-mail Tel one Number C•1 s t,ail THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FORTH 'ROPERTY. IDENTIFY-A L OF THOSE THAT A''. YES NO CONDITION YES NO CONDITION 0 ❑ 1.Will this property be the buyer's primary Q ❑ 3.Homestead residence? Provide complete address of prima y ❑ © 4.Solar Energy Heating/Cooling System residence,including county: 611 E Center Sl ❑ 0S.Wind Power Device Address(Number and Street) ❑ Q 6.Hydroelectric Power Device Hazleton, IN 47640 Gibso ❑ 0 7,Geothermal Energy Heating/Cooling Device City,State ZIP Code C tarty ID IZI2.Does the buyer have a homestead in Indiana to e ❑ 0 8.Is this property a residential rental property? vacated for this residence? If yes,provide ❑ 0 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: .i below. Please see instru ctions for mare information. " Not available in all counties.) Address(Number and Street) !'� G'j City,State ZIP Code County - 02• L/9- ID/- Cop . / /S- 0/ 9 Primary property r contact name E-ma' Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my wledge and belief,is ,correct and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Proper c osure Act".(Note: Spouse information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is being tit .) m Signet C� Signature of Buyer2/Spouse u t.t S- Z/ —ZO/ Karen Mdolly 5-;q-2r/9 Printed Legal Name of Sayer) Sign Date(MM/o0/rvrr) Printed Legal Name of Buyer 2/Spouse Sign Date(MM/Do/YYYY) Soc2Z 27 ?93 _ 038g9 oys85 Last 5 digits of Buyer I Driver's State Last 5 Digits of Social Security Number Last 5 digits of Buyer 2/Spouse Driver's State Last S Digits of Social Security License/ID/Other Number Number License/ID/Other Number