Homestead_Mazurier ., J
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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Britany N Bradshaw Agent
Preparer of the Sales Disclosure Form Title
226 W Broadway Broadway Title, Inc.
Address(Number and Street)
E-mail
z:E SELCER S GRANTO'R(S - f W S x w
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Columbia General Baptist Church, Inc.
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
PO Box 524
Address(Number and Street) Address(Number and Street)
Princeton,IN 47670
certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
andcom to as required by law,and is prepared in accordance with IC 6-1.1-5. ,"Real Property Sales Disclosure Act".
Signature ofSel er Signatur feller V v /
Bert Hyneman,Trus ee 0/ 400 Tracy Hurst, Trustee fo-z2-anP ,9 ^^A''( fSeller Sign Date(MM/DD/YYY)nnte ame o Se er S� n (M /DD/YYYY) Printed Name ofSeller
_. ' ;*1—.:---. _ '' "AV);;ff;G 7'IO V, OR I ROPER X�!'. DUC1`TONS P t1rI r VM THA P ' a `: t�
Heather Amanda Mazurier Joshua Taylor Mazurier
Equa 1-Name as appears on convey ocument Buyer 2•Name as appears on conveyance document
ve.,Apt 22 329 S 5th Ave.,Apt 22
Address(Numberand
Street) Address(Number and Street)
Princeton,IN 47670 Princeton, IN 47670
n _ _ E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FDA THIS .IDENTIFY ALL SE THAT PLr4 LOLO
YES NO CONDITION YES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary ❑✓ ❑ 3.Homestead GIB ON COUNTY AUDITOR CB
residence? Provide complete address of pri ary eating/Cooling System
residence,including county:1133 S 250 W ❑ ❑ 5.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device •
Princeton,IN 47670 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ 0 2.Does the buyer have a homestead in Indiana to be El 28•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: •elow.Please see instructio # more information.
Not available in all counties.)
Address(Number and Street)
City,State ZIP Code C. my 26-11-14-300-001. 987-027
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".(Note:
Spouse information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
being filed.)
Signature of Bayed Signature ofBuyer2/Spouse
Heather Amanda Mazurier Joshua Taylor Mazurier
Printed Legal Name of Buyer 1 Sign Date(MM/DD/YYYY) Printed Legal Name of Buyer2/Spouse Sign Date(MM/DD/YYYY)
Last 5 digits of Buyer 1 Driver's State Last 5 Digits ofSocial Security Number Last S digits of Buyer2/Spouse Driver's State Last 5 Digits of Social Security
License/ID/Other Number Number License/ID/Other Number