Homestead_Nelson (7) INDIANA SALES DISCLOSURE FORM SDF ID: Pa
ge 2
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Jeff Fox Title Coordinator
Preparer of the Sales Disclosure Form Title
3930 Mezzanine Drive,Suite C Columbia Title,Inc,
Address(Number and Street) Company
Lafayette, IN 47905
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Brian L.Holcomb Kassi L Holcomb
Sellcrl-Nanieasappeasson conveyance document Seller 2-Name as appears on conveyance document
2339 N Miller Reed I ane 2339 N.Miller Reed Lane
Address(Number and Street) Address(Number and Street)
Princeton,iN 47670 Princeton, IN 47670
City,State,and ZIP Code City,State,and ZIP Code
E-mail _
Under penalties of perjury,I hereby certi that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete as ye uired b •nd prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
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Signe of Seller Signature of Seller
i
`Brian L. Holcomb
C ; 2C'?-• r%Kassi L.Holcomb �� I Lo
Printed Name of Seller Sign Date(aMM/DD/YYYY) Printed Name of Seller Sr Date(MM/DD/YYYY)
Audree M. Nelson Kyley F.Nelson
Buyer 1-Name as appears at conveyance document Bayer 2-Name as appears on conveyance document
2687 Jill Drive 2687JiIl Drive
Address(Number and Street) Address(Number and Street)
E-marl
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTION PROut 09 2020
W.-IDENTIFY ALL OF THOSE THAT APPLiT
YES NO CONDITION YES NO CONDITION
❑ 1.Will this property be the buyer's primary VS ❑ 3.Homestead GIBSON COUNTY AUDITOR CB
residence? Provide complete address of primary ❑ Vir 4.Solar Energy Heating/Cooling System
residence,including county: ❑
i ` Y _ 5.Wind Power Device
Addu( un!b l dStreet) ( I , I/� ❑ Z. 6.Hydroelectric Power Device
7 t!�CVON 1 114 (0 CI I v),'L I ❑ 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ El 2. Does the buyer have a homestead in Indiana to be ID 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)
26-11-15-101-003.652-027
City,State ZIP Code County
Primary property owner contact name E-mail