Homestead_Brown (12) •
INDIANA SALES DISCLOSURE FORM SDF ID: Pa•e 2
D.PREPARER.,.
Thomas A. Carroll Attorney.
Preparer of the Sales Disclosure Form Title
227 St.Ann,Suite 224 Thomas A. Carroll PSC
Address(Number and Street) Company
Owensboro. KY 42303
E-mail
E:SELLER S 'GRANTOR S
Sandra Daniel
Seller 1-Name as appears Tag convey lee document Seller 2-Name as appears on convevance document
35 5�3 , , rr ive 5/7I
Address(Number and Street) Address(Number and Street)
Q a' o/S//' 'I /LJ 424 2 D:5
E-mail Tele•hone 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 u mplete as requ• •d by law.:nd is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller Signature of Seller
-•• II- -uI - _
Pri - -o Selle Milk Sian Date(MM/DD YY) Printed Name a Seller • `''ian Date(MM DD/YYYYI
F :IlitR S -GRANTEE S —APPLICATION FO' PROPERTY 'AX DEDUCTIONS—IDENTIFY A -411. 7S, - ' : PLY-
-•d :row Li.n-I M-si •n 0
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conve once dacum
209 West Street 126 S. Stout F
Address(Number and Street) Address(Number and Street) oft `c0
Patoka IN 4 666 Princeton, IN 47670 4•vO��! w0
City,State,and ZIP Code
erG�FySG\A Go E-mail
Telephone Number
E SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN': DUCTIONS FOR THIS PROPE: IDENTIFY ALL OF TH. _ :.T A� PPLY.
NO CONDITION S NO CONDITION
■ . , • •• • •• e buyer's primary C ❑ 3.Homestead
residence? Provide complete address of primary ❑ ❑ 4.Solar Energy Heating/Cooling tem
residence,including county: ❑ ❑ 5.Wind Power Device
' l
Address(Number and Street) E ❑ 6.Hydroelectric Power Device
Princeton IN 47670 Gibs,'n ❑ ❑ 7.Geothermal Energy Heating/Cooling Deice
City,State ZIP Code aunty \
- ❑ Q 2.Does the buyer have a homestead in Indiana.o be ❑ ❑ 8.Is this property a residential rental propecty,7\
' vacated for this residence? If yes,provide ❑ ❑ 9.Would you like to receive tax statements fd thi
complete address of residence being vacated, property via e-mail?(Provide contact information
including county: below.Please see instructions for more inform/tion\
Not available in all counties.)
Address(Number and Street) j
(DlQ- It-os- .00 -col, as t -0„),---1
City.State ZIP Code County
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