Homestead_Wilson (9) •
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER
Britany N Barnes Agent
Preparer of the Sales Disclosure Form Title
226 W Broadway Broadway Title, Inc
Address(Number and Street)
E.SELLER(S)/GRANTOR(S)
Mitch Breidenbaugh Marissa A. Breidenbauh
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
2373 E Top Hat Rd 2373 E Top Hat Rd
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670 Princeton, IN 47670
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 comp) to as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure ct".
Signature of Seller Signature of Seller
Mitch Breidenbaugh f 2// //1 ' Marissa A. Breidenbaugh /2 n
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller -,:—.7I S(n Date MM/DD YYYY)
F.BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITlS fts
__
Russelleilson
• e as appears on conveyance document Buyer 2-Name as appears on conveyance document
725E Evans St DEC 1'8 2019
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670
PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES
❑✓ ❑ 1.Will this property be the buyer's primary ❑✓ ❑ 3,Homestead
residence? Provide complete address of primary ❑ 2 4.Solar Energy Heating/Cooling System
residence,including county:2373 E Top Hat Rd ❑ 0 5,Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Princeton, IN 47670 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ .14 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 ❑ ❑✓ 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)
City, ,2�P _/A_ /6 -
2O0 -oo /.38/ _O a 7
StateZlPCode County
Primary property owner contact name E-mail
Number License/ID/Other Number