Homestead_Smart INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
c D.PREPARER
Steven L.Whitehead Attorney
Preparer of the Sales Disclosure Form Title
111 N.Hart Street
Address(Number and Street) Company
Princeton, IN 47670
E.SELLER(S)/GRANTOR( _._ _. .
Beverly Mae Johnson
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
110 S Kensington Drive
Address(Number and Street) Address(Number and Street)
Princeton. Indiana 47670
City,State,and ZIP Code City,State,and ZIP Code
Telephone Number E-mail Telephone Number E-mail
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,a d is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller
^(� v 1 Signature of Seller
Beverly Mae.Johnson
Printed Name ofSeller Sign Date(MM/DD/YYYY) Printed Name of Seller 'Shp De)e(M JDD/YYYY)
F.BUYER(S)/GRANTEEfS)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY-ALL I S P'L �
nthia J.Smart
Buyer 1- aappears on conveyance document Buyer 2-Name as appears on conveyance do3Er 2 0 2019
110 S.Kensington Drive aai� ff
Address(Number and Street) Address(Number and Street)
E-mail Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION ES- NO CONUITION—
[- 1.Will this property be the buyer's primary ❑ 3.Homestead)
residence? Provide complete address of primary ❑ 2 4.Solar Energy Heating/Cooling System
residence,including county:
❑ 0 5.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ 22.Does the buyer have a homestead in Indiana to be ❑ ❑✓ 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: below.Please see instructions for more information.
Not available in all counties.)
Address(Number and Street)
City,StateZlPCode County t?6, —I/ -IA — �Do1 s poi. Ye)A .�
Primary property owner contact name E-mail
Number License/ID/Other Number