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HomeMy WebLinkAboutHomestead_Cox f INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D P,REP.ARER Roman Ricker Partner Preparer of the Sales Disclosure Form Title 213 N Hart Street, PO Box 13 Partenheimer, Kinkle& Ricker Address(Number and Street) Company Princeton, Indiana 47670 E-mail E SELErk om,NTQR(S) J Lewis Fnterprises,LI C Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 109 W Locust Street Address(Number and Street) Address(Number and Street) Fort Branch Indiana 47648 City,State,and ZIP Code City,State,and ZIP Code E-mail Telephone Number E-mail Under .enalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct an' o 9 etAit re uired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". Artg Signature of.ell: Signature of Seller Peter J. Lewis,Managing Member 6/12/2020 Printed Name ofSeller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY) F.BUYER(S)/GRANTEE(S)__APP.LICATION FORPvRC+PERTYTAX;DEDUCTIONS�.�I,DENTIFY_, ; ,i_ _v_. T ., T�AI PL r,n,:,•_,,, _ _ , . �1Vlan yn J Cox L 1-j Buyer 1-Name as appears on'conveyance document Buyer 2-Name as appears on conveyance document 801 W Elm Street,Apt D JUN 15 2D7fl Address(Number and Street) Address(Number and Street) Haubstadt, Indiana 47639 City, THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION YES NO CONDITION s. 0 El 1.Will this property be the buyer's primary ti 0—❑3.-Homeste a ei residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: 203 W Locust Street ❑ ❑✓ 5.Wind Power Device Address(Number and Street) ❑ 0 6.Hydroelectric Power Device Fort Branch, Indiana 47648 Gibson ❑ IZ1 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ Z 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) ✓ s- jam- yo.y- 103-,,,,,75- City,State ZIP Code County Number License/ID/Other Number