Homestead_Blackburn INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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Timothy Shea Closing Services
Preparer of the Sales Disclosure Form - Tide
7820 Eagle Crest Blvd Ste 201 Regional Title Services
Address(Number and Street)
,rr 9a-tDuz{rt` 1h7F— Rma �•1x'-ti" K t• r. ts.= >,.r�1� �w.,'ar .--- :- ,�{.L— �. i tf`.`,�.. 1'.atl ,, v
•,• •_� r 9a�s"�.�54� �i!"�L•xF'tilinFS.v �"� c, s l� ,�'aZ.'(�-:
Dennis R.Burns Karen K.Burns
Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document
24400 S TamiamiTrail Lot 112 24400 S TamiamiTrail Lot 112
Address(Number and Street) Address(Number and Street)
Bonita Springs,FL 34134 Bonita Springs,FL 34134
Telephone Number E-moll
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and corm"plete.4-7722 asere red by law,and is prepared in accordance with� IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
ature of Seller �( atdbme of Seller
Dennis R.Burns Ni -- ? `/q Karen K.Burns x 7 - /qJ
Printed Name of Sc Sign DateWM/OD/YYY) Printed Name alter Sign Date(MM/DD/YM)
Rf
11—.:71 ICI FICIRIF.ORkP.ROP_BRiI '.....EDUC9FION....'17SI1'#AL•Ilr'Pltl?MS.....IDS.....PLY '.....(9f�t'- -..n...1
Melissa Blackburn
1-Name as is on conveyance ocu t Buyer 2-Name as appears on conveyance document
I 8AI—(
(Number.aaa Address(Number and Street)
.124t - ‘i7/P70
- /
Aug 00 2019
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS1RO• ' • .. ..•-r• • i OSE THATAPPLY. /l, , e rt1
YES NO CONDITION % YES NO CONDITION \ ,r/'e'/��'•�,"Y��`�`
[ 0 1.Will this property be the buyer's p •I �J 0 3.Homestead ,IBSON COUNTY AUDITOR CB
residence? Provide complete addre- of primary ❑ H 4.Solr_Enefgy Hea ' g/Cooling System
residence,including county:
1195 S Hoot Owl Lane ;n� r evice
Address(Number and Street) `B�10 6.Hydroelectric Power Device
Princeton, 47670 Gibson 0 Ei7 7.Geothermal Energy Heating/Cooling Device
City,State Code County
8.
0 2.Does the buyer have a homestead in Indiana to be 0 9.Is this property a residential rental property?
vacated for this residence? If yes,provide 0 ElWould ecerve nts for this
complete address of residence being vacated, erty via e- rout contact in o on
below. see instructions rmado
including county: available in all counties.)
Address(Number and Street)
Melis Blass bum 26-11-16-400-000 . 147-0p
Clry,State ZIP Code County Primatyproperty ow tact name all
Number License/ID/Other Number I