Homestead_Church •
INDIANA SALES DISCLOSURE FORM SDF ID
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JILL COOPER CLOSING AGENT
Preparer of the Sales Dlsdosure Form Title
520 MAIN STREET.STE.1 CENTRAL LAND TITLE
Address(Number and Street)
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.IFNNIFFR Fl IZABELli9@1SI INRFR
Jr.Nam,as appeors n conveyance document Seller 2-Name as
'' a /`. _ � � appears on conveyance document
'�c s(NumberandS 'et) �Q/^�' Address(Number and Street)
/\ UU�C CD (do%uuAo arks,,,-,_ Fr:`acp I v-
City,State,and ZIP Code J 7.5v33 City,State,and ZIP Code
_L8121385-6196
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
an complete as equired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
U n lure ofSeller Signature of Seller
Je fer Elizabeth Anslinger io/Z_ 6
sited Nemec) n Date AIM D Printed Name of Seller
. �.` I >s ' - - - - n Date fMdf/AD/YY}'J=5�.
b RA.A.- J: .AP l rc LotOO a t Ira t QVS SI1),8nr z `r irsfi ; P--• ' �ig-Y h � F
S CAROLYN A_CHURCH
•• • ••- - . conveyance document Buyer2-Name as appears on conveyance document
5697 N.OLD US HWY 41 SAME ;
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Address(Number and StreetJ Address(Number mid Street) "�'U �' f�,>,
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� E-mail ;.
THE SALES CLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PERTY.IDENTIFY ALL OF THO T APPLY. 4ry, .(n` i
YES NO CONDm0N YES NO CONDITION '-1,
❑ 1.Will this property be the buyer's primary ❑ 3.Homestead -'6i.,
residence? Provide complete address of primary eating/Cooling System0,?
residence,including county:
❑ ❑✓ 5.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
City,State ZIP Code coon ID 0 7.Geothermal Energy Heating/Cooling Device
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❑ El2.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 ❑ 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' all counties.)
Address(Number and Street)
26 -6il-/0a - c/o 000 GZG 612
City,State ZIP Code County
Primary property owner contact name E-mail