Homestead_Riley (6) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
I)NAR6P,ARERS�� ;. ram- { > 37L�� i�a ",r�4"t�'�ap 2x'- e �'.4���"a4—Ka�',.'
Timothy Shea Closing Services
Preparer of the Sales Disclosure Form Title •
7820 Eagle Crest Blvd Ste 201 Regional Title Services
Address(Number and Sireed
-.-'iaezi ..^I_." ' is ��. a a- :tx mac: •i_ ,x„ r .0
itgvn
Shaylon N. Pierce
Seller 1-Name as appears on conveyance document Seller I-Name as appears on conveyance document
10669 E 100 S
Address(Number and Street) Address(Number and Street)
Oakland City,IN 47660
to the best of my knowledge and belief,is true,correct
and C\Q'\�mtpleetee as a {rreciuiired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
N.
Signature of Seller — d - /� ���� //11I/�_ Signature of Seller
Shaylon N.Pierce 'O4 92/1/
Printed Name of Seller Sign Date(((MM/OD/rir17 Printed Name of Seller Sign Date(MM/DO/nY1)
k R(S111G EE(S1TVAEP.LtIGAif10NiFORPITOPERTYTAXiDEDUCTIONSEIIDENTIEYdAWITEMSi lHAIVAP.P.LY 3
Robert P. Rile Peggy S. Riley
er mnon conveyance document Buyer 2-Name as appears on conveyance document
5235 S 875E 5235 S 875 E
Address(Number and Street) Address(Number and Street)
Oakland City,IN 47660 Oakland City; IN 47660
THESALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. FILED
YES NO CONDITION :+ NO CONDITION
1.Will this roe be the buyer's primaryJun 11 2010
❑ property rty y D 3. Homestead
Provide complete address of primary ❑ p 4.Solar 1- =eating/CooAsa-
residence? m
residence,including county: p 5.Wind Power Device GIBSON COUNTY AUDITOR CB
10669 E 100 S
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Oakland City,IN 47660
Gibson ❑ p /7.Geothermal Energy Heating/Cooling Device
It-c1(y stare ZIP rode County
❑ 2. Does the buyer have a homestead in Indiana to be ❑ ,U-LI 8. Is this property a residential rental property?
ik eive tax statements for this
vacated for this residence? If yes,provide ❑ Q -yeu-1
complete address of residence being vacated, property via e-mail?(Prove ntact information
p{ including county: below. Please see instructions for m 'nformation.
'/LJ5 S. 275 N- ��26-13-13utdta.atS6LYmta
Add ( umber ndStreet) Robert P. e
mi P;tU -jl/ taco Gib7or Rileyy ggy y
City,State ZIP Code U ' County Primary property owner contact name E-mail