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Homestead_Mizeur INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D PREPARER.__. _,1 _ =t - - -•- - - 2.,_e:_ :..._ _. .. ... _ ;,- = - __y_ - -_ - -__.--___ ,:i Leon C. Stone President Preparer of the Sales Disclosure Form Title 226 West Broadway Street Broadway Title, Inc. Address(Number and Street) City,State,and ZIP Code _ Telephone Number E-mail E SELLERJS)/GRANTOR(S):,- _ : ' _ ,, _ Terri Lee Hurst ._ __._. _ Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 5136 Southlake Drive Address(Number and Street) Address(Number and Street) Fvansville IN 47715 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 c mplete as required b law,an is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". cy al- Signature of Seller Signature of Seller Terri Lee Hurst 1 1/-1 /Q Printed Name o Seller I Si.n Date MM DD Printed Name o Seller . 71MY Date(MM DDIAgai F:0-1:1y:B:ik(8-y/6 RANTEM,:t APPLICATION_,#FOR PROPERTY TAX D:EDUCTIONSt IDENTIFY AL LATMEi einri I*Broderick Mizeur - 1 q(� Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyanced{ggl e5 4 Ze 1 J 541 S. Concord Drive - ����VV Address(Number and Street) Address(Number and Street) Princeton, IN 47670 ( 1 ,OR City,State,and ZIP Code City,State,and ZIP Code l "tout' 11 NU�� ( 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 YES NO CONDITION Z El 1.Will this property be!the buyer's primary L_Z_0 3:-Homestead_,.._2 residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: 211 E. School Street ❑ ❑✓ 5.Wind Power Device Address(Number and Street) ❑ 0 6.Hydroelectric Power Device Patoka, IN 47666 Gibson ❑ Z 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ 0 2.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 ❑ IZI 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) r _ _ City,State ZIP Code County r 2- 77�`3�- � �� ©I Primary property owner contact name E-mail Number License/ID/Other Number