Homestead_Wilson (2) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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Patti Kolb Closing Manager
Preparer of the Sales Disclosure Form Title
226 W Broadway St. Broadway Title. Inc.
Address(Number and Street) Company
Princeton, IN 47670
<E SELLERaIGRalte{s) iV 2 W r ._,.rS.,. ,._, ... „ _. _ _ O: _ ---,-OONNOv ._ . -„_._. .
Oakland City Fyecare, LI C
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
251 N Main St
Address(Number and Street) Address(Number and Street)
Oakland City, IN 47660
City,State,and ZIP Code City,State,and ZIP Code
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 comple as required by law,la a is prepared in accordance with C 6-1.1-5.5,"Real Property Sales Disclosure Act".
ry 1� � O� r 00
Signature fScB� ���� gnatureofSeller
Jeffrey D.Irvin,O.D. /1-y-t y James C. Bigham. O.D. Ii—y^/ l
Printed Name ofSeller S(qn Date(MM/DD/YYYY) Printed Name ofSeller SW Date(MM/DD/YY f)
:E BI _::: t{S')_,_Al?pi-IGAq'II tilWRP_1t0kEg3'YrMar l!CTIC+NSn,I M]YALLrITEIUI H1 :ApP..L N y_ sESM
(Crystal K.Wilson
Bum as apaears.on conveyance document Buyer 2-Name as appears on conveyan a en r Tr:
128 S.Main St. I_Li 11.2,1
Address(Number and Street) Address(Number and Street)
Oakland City, IN 47660 NOV 0 6 2019
City,
/ _
Telephone Number E-mail Tele umber ----------_ / • E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FORTH ROPERTY.IDENTIFY ALL OF TH SIBSON du NTY AUDITOR
YES NO CONDITION YES NO CONDITION
gi ❑ 1..Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary 4 SnIar hnergy.Heating/Cooling System
residence,including county: ❑ gi
128 S Main St 5.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Oakland City, IN 47660 Gibson ❑ IZ 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ 2.Does the buyer have a homestead in Indiana to be ,
❑ 0 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 0 9 receive tax statements for this
complete address of residence being vacated, property via e-mail?(Pro ' ntact information
including county: below.Please see instructions for mo ormation.
Not available in all counties,)
Address(Number and Street) at-ILi -11 - oti -000 9s--- -one- a
City State ZIP Code Coun
a property owner contact,,lie -mail
Number License/ID/Other Number