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Homestead_Mroz (2)
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 ofD��7A y�1r+ 1.A 1.2L - t-- 7- 4- s$ -1. ill -Z, _� , ...,�,,,� +�-s . .z-k f- . w ;{V _{] _.� .. -..-: - ''� _=.'sue- ,�... \ _, !-" _- --' - ,,..-,.1 ._ - r...,.._ _ - Jeanette Gomez Escrow&Title Processor Preparer of the Sales Disclosure Form Title 3930 Mezzanine Drive,Suite C Columbia Title, Inc. Address(Number and Street) Company Lafayette, IN 47905 mail Jordan Mason Seller 1-Name as appears conveyance document Seller 2-Name as appears on conveyance document dress(Number and Street) Address(Number and Street) EuC1,►n S C Ok.-P .--SLo L r i1 City,State,and ZIP Cade ' City,State,and ZIP Cade Number E-mail Telephone 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 compl, e as require by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". %O // Sign re of Seller Signature of Seller Jordan Mason 4/10/2020 Printed Name of Seller Y Y Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/m s) Egr B R s rIRA�I ODI;:—eZEI ];fi ORral iota r TMMOO DISCLOSURE FORM MAY HE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE: Apr 16 2020 YES NO CONDITION YES NO CONDITION J 10 0 ❑ 1.Will this property be the buyer's primary FA ■ 3.HomesteadT� residence? Provide complete address of primary IA 4.-Nola ergy eating/N COUNTY systAem CB residence,including county: ❑ ® 5.Wind Power Device 319 West Spruce Street Address(Number and Street) ❑ Z 6.Hydroelectric Power Device Princeton, IN 47670 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County El 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 ❑ RI 9.Would you like to receive tax statements for this complete address of residence being vacated, rty ia-e- '1? Provide contact information Including county: below.Please see instruct-to ore information. Not available in all counties.) Address(Number and Street) -12-07-101-002 . 963-028 City,State ZIP Code County Primary property owner contact name E-mail