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Homestead_Mitchell (2)
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D PREPARER Roman Ricker Partner Preparer of the Sales Disclosure Form Title 213 N Hart Street, PO Box 13 Partenheimer, Kinkle&Ricker Address(Number and Street) E-mail E SEELER(S)/GRANTOR(S);_ , Lewis Enterprises, LLC 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 Brandt Indiana 47648 City,State,and ZIP Code City,State,and ZIP Code hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct an c to as eq ired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". Signature of Sell r Signature of Seller Peter J. Lewis. Mana Memeber 8/6/2020 Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/rriY) `;GRANTEE S)- ICA_ APPL '-OPERTY,TAXDEDUC+. INS-IDENTIFY , PPL TAY "_ _ y - ,,,, Jana L. Mitchell -;a Buyer 1-Name as appears on conveyance document Buyer 2 Name as appears on conveyance docu n, 411 201 W. Locust Street " Address(Number and Street) Addr.s(Number and Street) A�6' i. , . Fort Branch, Indiana 47648 20 City,State,and ZIP Code City�tnte, 20 E- - Telephone Number //iv k E-mail THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN I,%I CTIONSTOR S PROPERTY.IDENTIFY ALL HTFO OSE FHA A YES NO CONDITION YES NO CONDITION ILZI ❑ 1.Will this pro.• • .• e buyer' primary Z ❑ 3.Homestead -'.• ce? Provide complete a dress of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: 201 W.Locust Street El ❑✓ 5.Wind Power Device Address(Number and Street) ❑ 71 6.Hydroelectric Power Deli Fort Branch, Indiana 47648 Gibson nergy 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. x statements for this complete address of residence being vacated, ro erty via e-mail?(Provide co t information including county: below.Please see instruc ore 1 rmation. Not available in all counties.) Address(Number and Street) City,StaleZIPCade County ��-- ' Number License/ID/Other Number