Homestead_Smith • ! _ALES DISCLOSURE FORM SDF ID: Pa:e 2
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---,are; e a es c osure Form4 Title
Ad:,.;ss(Number an,Street) 2 Company
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Telephone Number E-mail
ER(S GRANTOR S)
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`1e • I• e as ears on c'.` ,anc;-d.c on Seller 2-Name as appearsconveyance document
d,ress Number`, / Address(Number and Street)
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Telephone Number
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Unde •.•nalties of perjury,I hereby .ertify that this SaletDisclosure,to the best of my knowledge and belief,is true,correct
1 .Iete as require by 1 w,a d is ! ..:r•d in ccordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
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'.r•utyt e of ler ttCez, Signature of Seller
a• SVler Date MM DD YYYY) Printed Name o Seller C ,Dat.MM/DD/YYYY)
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:U;�E'(S G' .TEE ) - ' '' -, ATION Fe R PR PERTY TAX DEDUCTIONS-IDENTIFY ALL ITE
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,1 B rI - a•o ears onc s • •.o ument W / _ Buyer 2-Name as appears on conveyance docIdf52 4 2020
• • es (Numbei and 5,-- , - Address(Number and Street)
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Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YE NO CONDITION
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❑ 1.Will this property be the buyer's primary LI 3.Homestead
residence? Provide complete address of primary ' 1F„..,L.,
al 4.Solar Energy Heating/Cooling System
residence,including county:
❑ -A 5.Wind Power Device
Address(Number and Street) ❑ FA 6.Hydroelectric Power Device
❑ 01 7.Geothermal Energy Heating/Cooling Device
City, at I Code County
El 2.Does the buyer have a homestead in Indiana to be ❑ aIs this property a residential rental property?
vacated for this residence? If yes,provide ❑ Ti 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) q u/
ego. bet-5 - ,j. - ooa. 0•71 -"9
City,State ZIP Code County
Primary property owner contact name E-mail
Number License/1D/Other Number