Homestead_Patterson INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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iD*P.REPARER '_ —, . ,. _,
Rav M. Drulev Attorney No.4759-26
Preparer of the Sales Disclosure Form Title
505 N.Church Street,PO Box 146 Law Office of Ray M. Drulev
Address(Number and Street) Company
Fort Branch. IN 47648 812-753-4975 drulevlawea vahoo.com
City,State,and ZIP Code Telephone Number E-mail
iE:SELLER'(S)7GRANTOE(s): ,,.— t zs : -71:7"V.57;77-'7-47:Y ..�- 71:94-.7177:=7.--r ` . ,•
Scott St Clair Sr
Seller l-Name as appears on conveyance document Seller Name as appears conveyance eysnce document
Alai t l)rl/mw1,7f("
Address(Number and Street) Address(Number and Street)
Owensville IN 47665
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller /� ���J� Signature of Seller
Scott St Clair Sr, ro G0-s' -�. 12/5/2014
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MMMD/YYY1)
tiBUYER(S)7GRANTEE(S)F APPC ICATIONWORPROP.ERT,Y,TAX;DER.UCTIONSaIDENTIFYTALI ITEMSlTHAT,AeRIY c tJT7''
Tamara Name Patterson ae n 1J �I'
Bvyerl-A'amevs appears on conveyance document Buyer 2-Name as appears on conveys e a en f
201 S. Scott Street
Address(Number and Street) Address(Number and Street)
Owensville. IN 47665 DEC 11 2014
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF TI�NETITO AT PLy Pi, AUDITOR
YES NO CONDITION '0 CON .
0 ❑ 1.Will this property be the buyer's primary C. Fl ❑ 3.Homestead
residence? Provide complete address of primary u U 4.Solar Energy eating/Cooling System
residence,including county: ❑
201 S Scott Street S.Wind Power Device
Address(Number and Street) ❑ 1g 6.Hydroelectric Power Device
Owensville, IN 47665 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
El 15I 2.Does the buyer have a homestead in Indiana to be ❑ 6.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 19 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: below.Please see instructions for more information.
Not available in all counties.)
Address(Number and Street) a 40- /8-07-1 o3-cop. 3 6f- c9 a,
City,State ZIP Code County
Primary property owner contact name E-mail