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Homestead_Miller
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D.PREPARER • Rexanne McCauley Title&Escrow Processing Preparer of the Sales Disclosure Form Title 3930 Mezzanine Drive, Ste C Columbia Title, Inc. Address(Number and Street) Company Lafayette, IN 47905 Number E-mail E.SELLER(S)/GRANTOR(S) Jonathan E. Miller Kerni N. Miller Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 422 Fairmont Avenue 422 Fairmont Avenue Address(Number and Street) Address(Number and Street) Mishawaka, IN 46545 Mishawaka, IN 46545 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 complete as required by law,and is prepared in accordance with C 6-1.1-5.5,"Rea ty Sales Disclosure Act". ignature of Seller Signature of Seller /2019 iller Jonathan PriintedN meofSelllr ler SignDatte(M1M/DDD/YYYY) Kerd N.PrintedNameofSeller 110114I y AiNnOG PJGS�I�1 0 2019 —Wm-Date(MM/DD/YYYY) F.BUYER(S�GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY'ALL ITA y1:''' AdIQ°I Y ` 1 David R. Mille e - •ame as appears on conveyance document Buyer 2-Name as appears on conveyqvffg,d�c e 304 North Cross Street 0`�G nON Address(Number and Street) Address(Number and Street) Francisco, IN 47649 1 I r-y Tr t,_I City,State,and ZIP Code City,State,and ZIP Code k' 1 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 NBtf�A 0 ❑ 1.Will this property be the buyer's primary 17I ❑ 3.Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: 304 North Cross Street ❑ ❑✓ S.Wind Power Device Address(Number and Street) ❑ 0 6.Hydroelectric Power Device Francisco, IN 47649 Gibson ❑ z 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ 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 ❑ 17I 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) rt6 - ! .3 -I? - 303 -00eo o/-oo.S City,State ZIP Code County Primary property owner contact name E-mail