Homestead_Moser Jr INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D PREPARER• _ - . -_ -_ 3-_: :
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 (
E-mail
_E SELLER(S)/GRANTOR(S),-. :_... '-1 ... - .
Hugh L.Wirth Ruth F.Wirth
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
4 36sD• ScLiomen er St 41 t 30.573 9e-hO01er St--
Address(Number and Street) Address(Number and Street)
60 /leaf Poi--I- F( 3Yz9/ 0 Alr.'k POI* f 3 'Z9/
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 co ete as required by law,a d is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
t __ } ___,LIJ.-1
Signatur ler Signature of Seller
LYVI-h v Ruth E.Wirth 3- 6.?o
Prlata Name ofSeller Sign Date(MM/D YY) Printed Name of Seller Sign Date(MM/DD/YYYY)
:yej_UYER(S)/GRANTEE(S) AO?LICAtT6KFORP_RQPERTYTA EDUCTIDNS__IDENTIFYALL-ITEM _`ii PPLY ___.,_
Donald L. Moser, Jr.
Buyerl-Name as appears on conveyance document uyer2-Name asappe o onT an a nent
7146 E State Road 64 ' 3
,LO
Address(Number and Street) Address(Number and S t)
Francisco, IN 47649 \Pe\ 4y L I/
E-m ' Telephone Number I ��� E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN D CTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOS PAPPLY.
YES NO CONDITION YES NO CONDITION ct,w
's property be the buyer's primary ❑ 3.Homestead
residence? Provide complete address of primary
❑ ❑✓ 4.Solar Energy Heating/Cooling System
residence,including county:
411 West Oak Street ❑ 05.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Oakland City, IN 47660 Gibson ❑ El 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ ❑✓ 2.Does the buyer have a homestead in Indiana to be 0 ❑✓ 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ z 9.Would you like to— receive tatements for this
complete address of residence being vacated, via P-mail?_arovide con information
including county: below.Please see instructions for more ' ation.
Not available in all counties.)
Address(Number and Street) I ,, QQ ^�-\ ''��^^�� ,{� 007
City,State ZIP Code Coun
Dll.c-M-"'\ O -, 01 OO • 1C-
Primary property owner contact name -mail
Number License/ID/Other Number