Homestead_Baleda 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) Company
Princeton, IN 47670
mail
E.SELLER(S)/GRANTOR(S)
Randall L. Hurst Valerie R.Hurst
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
908 S Gibson St 908 S Gibson St
Address(Number and Street) Address(Number and Street)
Princeton, IN 47670 Princeton, IN 47670
City,State,and ZIP Code City,State,and ZIP Code
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 law,and is prepared in accordance with 1 6-1.1-5.5,"Re Property Sales Disclosure Act".
rgnature of Se ler Signature of Seller
Randall L. Hurst /—/ 3-,R Z Valerie R. Hurst Fi .111(
• IX p
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller �n►at ,;rv/rrm
F.BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL ITEM S THAT APP '
�Carl W Baleda JAN ?
uuyer i- 'ame as appears on conveyance document Buyer 2-Name as appears on conveyance document `020
516 E 7th St
Address(Number and Street) Address(Number and Street) I�
Mount Carmel, IL 62863 GIRSON COUNTY MIDI I OR
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 rf9FF3odc
❑✓ ❑ 1.Will this property be the buyer's primary ❑✓ ❑ 3.Homesteaa
residence? Provide complete address of primary U f 4.Solar Energy Heating/Cooling System
residence,including county:
603 E Broadway St ❑ I] 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
❑ E 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)
076 —1 A —0 7 - Li 0"6 3.192,01.8
City,State ZIP Code County
Primary property owner contact name E-mail
Number License/ID/Other Number