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Ray M. Druley Attorney
hrpvrv aJNr Salu Dittlosure Form Ttle �
505 N. Church, P.O. Box 146 Law Office of Ray M. Druley �
Addrvs (Number and Street) Company
Fort Branch� IN 47647
E-mail
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Under penalties of perjury, i
anc�co�nplete as re�i�ed by
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w�er �- nome as oppmrs am m�ve}vnn aa�umm�
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Address (Num6er and SVttt)
Ciry, Smtt and LV Code
by certify that [his Sales Disdosure, [o [he best of my knowledge and belief, is true, correc[
and is prepared in accordance with IC 6-1.1-S.S,�,Real Property Sales Disclosure Ac[".
Bvye� 2- Nome as oppears o^ ronveyvnteQxvmmt
Addrevs (Number andSVmtJ
Ciry, Smtt andLPCode
THE SALFS DISCLOSURE FOI1M MAY BE USED TO APPLY i0R CERTAI4 DEDURIONS FOR THIS PROPERTY. IDE\TIFY ALL OF TNOSE THAT APPLY.
Q� 1. Will [his property be the buyer's primary '
residence? Provide complete address of primary
residence, including county:
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rat Num rond5treelJ
_�r��rah�h. T�V '�76 G; bsoh-
Ciry,5m4ZIP ode �— County
� �. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated,
including counry:
Addrm (Numberand Sveet)
cry s�r�vv�e�
� � 3. Homestead
4. Solar Energy Heating/Cooling Sys[em
� � 5. Wind Power Device
❑ � 6. Hydroelectric Power Device
❑ � 7. Geothermal Energy Heating/Cooling Device
� � 8. Is this property a residential rental property?
� �9. Would you like [o receive [ax statemen[s for [his
property via e-mail? (Provide contact information
be(ow. P/ease see instructions for more infarmatlon.
Not availa6(e in all counties.)
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o.r,..�.., �.,..�..w�,.�.. r��m�r �ame E�mail
Under penalties of perjury, I hereby certify that this Sales Disclosure, ro 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/O[her numbers are not necessary if no Homestead Deduc[ion is
b�fn�filed.) �
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