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_INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER - = - -" _ - _ - 1
Leon C. Stone President
Preparer of the Sales Disclosure Form Title
226 West Broadway Street Broadway Title, Inc.
Address(Number and Street) Company
Princeton, IN 47670 (812)386-1687
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)LGRANTOR�S� __ _ _ _ _ __
James G Collins&Betty L Collins-Revocable Living Trust -
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
334 S Seminary Street
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670
Cgi&..-
State,and ZIP Code City,State,and ZIP Code
ce�7—)5Oc
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 required y lawDd is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signaturi.fSeller) -1 l Signature of Seller
Angela J. Ford 1 f��- q
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller xED
(MM/DD/YYYY)
1.
E -APPLICATIONFOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL I S TH- '
F.BUYER(S /GRANTE�S) _ _ _ _ _ _ _ _ . . _
Jennifer M.Jenkins d,Kb��1c 2 2 Z0�9
tluyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance do
1903 Cottonwood Drive
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670 GI8SOW COUNTY AUDITOR
City,State,and ZIP Code City,State,and ZIP Code
(812)779-9465
Telephone Number 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 Y ON
0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
. residence? Provide complete address of prima — U }- ergy Heating/Cooling System
residence,including county:
334 S. Seminary Street ❑ ❑✓ 5.Wind Power Device
Address(Number and Street) ❑ g 6.Hydroelectric Power Device
Princeton, IN 47670 Gibson ❑ g 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
El 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 ❑ 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)
a6 - /a - 07 - Ye/ - 000. cfci,3 -vap
City,State ZIP Code County
Primary property owner contact name 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 IC 6-1.1-5.5,"Real Property Sales Disclosure Act".(Note:
Spouse information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
being filed.)
l IA_411111i6....a.
Sig "lreofBuy, 1 Signature ofBuyer2/Spouse
.lannver M Jenkins Ltil 9apa lG
Printed Legal Name of Buyer 1 Sig Date MM/DD/YYYY) Printed Legal Name of Buyer 2/Spouse Sign Date(MM/DD/YYYY)
(Og 0 tri I 0 5aS35
Last 5 digits of Buyer 1 Driver's State Last 5 Digits of Social Security Number Last 5 digits of Buyer 2/Spouse Driver's State Last 5 Digits of Social Security
License/1D/Other Number Number License/ID/Other Number
I — _ — .. _ - _ - -