Homestead_Small INDIANA SALES DISCLOSURE FORM SDF
ID:
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Chris Sullivan Closer , ,
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Ste 201 Regional Title Services
Address(Number and Street)
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Benjamin F.Kixmiller
Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document
' Address(Number and Street) Address(Number and Street) I
-ilaz-elton-4764U V 'I 1VC-j i\,4-C-) I ( N vl--"/59 I State,and ZIP Code
state,ana zl r Loae
Telephone Number E-mail
(
E-mail I •
Under pe Ities of perjury,I eby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
an co etZ as requi w,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
I attire of er ` Signature of Seller i
Benjamin F. 'xmiller ,\ICI OP--() ,
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller I Sign Date(MM/DD/YYYY)
`- ''' Ar.:.l•_ � N PEE(=5�1 -,'/1AFT;ICAsTION�R ilfilROP•E1flW4'I`A IAtiUi itir,V+ItDBNTIFY ALL'T-'ftg]'vlSi'IiHAfI':APPEY. . -._ ,,G .., -.
Bryan M. Small' Melissa.A. Small
acne as appears on conveyance document 1 Buyer 2-Name as appears o veyanc a document
296-4tlrSf� �I? Cl/ : �-d S'i , 5 206 4th St _\tikA-,{`'
Address(Number and Street) Ad ress(NumberandStreet)
FandSGe' pc_it-2.- ( tom.n t k NI -I -:(9C-C 7649 S ,ti._)! ._-e._
I g-mall
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROP'' . • • . I.THOSE THAT AI PPLY. Feb 24 LOLO
i
YES/ NO CONDITION YE NO CONDITION I 4Wi
�7l ❑ 1.Will this property be the buyer's primary [] ❑ 3.Homestead GIBBON COUNTY AUDITOR CB
residence? Provide complete address of primary ri';.'•'.•.r,4. • _' eating/Cooling System
residence,including county: ❑ I
5
6797 N St Rd 65 I S.Wind Power Device
Address(Number and Street) ❑ 1 6.Hydroelectric Power Device
• •Hazelton,IN 47640 Gibson ❑ El 7 7.Geothermal Energy Heating/Cooling Device
State ZIP Code County ❑ 8.Is this property a residential rental property?
[ ] ❑ 2.Does the buyer have a homestead in Indiana to be ❑ Q 9.Would you like toreceive tax statements for this
vacated for this residence? If yes,provideproperty via e-m ' . vide contact information
complete address of residence being vacated, below.Please see instructions ore information.
including county: i
° U 4, S Lt.R, 3}- . Not available in all counties,)
•Address(Number and Street) 26-06-06-300-002 . 757-017 '
• C'( Bryan M. Sma sa A. Small
City,State ZIP Code County E-mail