Homestead_DeWitt •
INDIANA SALES DISCLOSURE FORM SDF ID:_ Page 2
{D`. REI ARER `'_ - 1`r -mt-; 1 5.,!_ •it- #'"z,1'• _it,S�(s`'.'--L+f - -y` 'f'f.Le ''•-it
Preparer ofthe Sal Disclosure Form title .
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Email
t_E:SEBLER(S)J,GRANTOR(S)a... '-4' F r >- _.
N.P.DODGE,JR,TRUSTEE
Seller Name as appears on conveyance document Seller 2-Name as appears on conveyance act:
2707 N.118TH STREET
Address(Number and Street, Address(Number and Street) JUN 0 7 2019
OMAHA.NE 68164
City.State,and ZIP Code City,State,and ZIP Code
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Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my kncogig �f sA 8c'ect
and complete as required by law,and is prepared in accordance with IC 61.1 5.5, "Real Property Sales Disc osure t .
V.a.Jc d SA J.+•.• iw71.e.
BY: 07 ft,.t-/ wl,N. o1it€'I1,5 Vice-,-, :Witty(
Signs ureofSelter:.
Few (Ucr�%IFh.I iu,4'a,{-s-(12;.dJ eLgrn '-c"- f`a1- Signature ofSeller
N.P.DODGE,JR.,TRUSTEE S-2 c7 k k
Printed Name ofSelle" _ Sian Date(AfM/DD/YYYY) Printed Name of Seller Sian Date(MM/DD/Yr1}7
F ER(5)/GRANTEE(S),,APPIRAT10N'TR-PROP,ERTYTAXtDEDUCTIONS',4ENTIFY%AL'L•ITE 1517.fATIAPPLY _- J-_ .,-`
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IBuvr I-Name assaappears on conveeance document Wryer =e asaatre,rs an conveyn document
on Ihmnvl'C (fir �� \N IL�11�_)\C_Jrr'Jl-off
A "ess(A um etf' Address(Number anQS;eet)
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CERTAIN DEDUCTIONS FOR THE PROP ENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITIONS YES NO CONDITIONS
* ❑ 1. Will this property be the buyer's prima ce.. ❑ 3. Homestead /Cooling ystem
residence?Provide complete address of rimary Inc Lt1e eating
residence,including county:
❑ CS(..)5. Wind Power Device
❑ 6. Hydroelectric Power Device
❑ ❑ 7. Geothermal Energy Heating/Cooling Device
Address(Number and Street)
o11^iS `� ❑ �8. Is this property a residential rental property?
❑
rin• tarezlPfode County 9. Would you like to receive tax statements for
❑ 2. Does the buyer have a homestead in Indiana to be this property via e-mail?(Provide contact in-
vacated for this residence? If yes,provide form se ewe instructions for more inf
complete address of residence being vacated, rrmatlon.tavaiiob,einancoude
cludingcoun-�• vr� .b 6-2-c00 -oat r-02-1
�ntccri �.7. �-i-a v \ tj
'mary property owner contact name Email
City,State ZIPCode County _