Loading...
Homestead_Coomer (12) INDIANA SALES DISCLOSURE FORM SDF ID: Page ISKOMI7�;t:�svgitti",k 3tat.,,... iN. .�,..xY„5*�',...at.��_ ..>.�r..:�'f.'�-'S-.INEEM,5. iE .,v.�� .,3..r...e x z t ,,, y4 NV E ,}.c, Patti Kolb Closing Manager Preparer of the Sales Disclosure Form Title 226 W Broadway St. Broadway Title, Inc. Address(Number and Street) Company Princeton, IN 47670 E-mail E SELfIEi2(S G NT(lR(S) 'r ,�s �,W � f- ... . ..` .- " ' : l )/...� Cr�� ...�...a� ._.,'i.._��3���P....5+mac."'M:�;,_� �>'..�,.'�'"` �.�'� '�,i x _ ,`�� tiff _ t,.- ���a_.,- '^mod �� S�y �? ao�� v �.::r; Kaye L.Cates,Trustee of the Shoult7 Family Trust dated 9/23/2011 Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 7101 N St Rd 65 Address(Number and Street) Address(Number and Street) Hazleton, IN 47640 E-mail Telephone Number E-mail Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct n complete 4s required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". ( tom. Sig Cure of Seller Signature of Seller Kaye L.Cates.Trustee /0/Q /20 Printed Name ofSeller SO Date(MM/DD/YYYY) Printed Name ofSeller Sign Date(MM/DD/Yrr}) >W 14Wti (S)/G .dTEEMIAWLICATION QR,PROPERFTY_aTA D.Z1WtTIONS DENT FMntI '.),MSTHAraWZ 'µ s1 .._`.S2 James M.Coomer Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document 5920 W 200 N Address(Number and Street) Address(Number and Street) Patoka, IN 47666 City,State,and ZIP Code City,State,and ZIP Code F I L E D FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY. , YES NO CONDITION YES NO CONDITION [T ❑ 1.Will this property be the buyer's primary ❑ 3.Homestead GIBSON COUNTY AUDITOR CB residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System • resi e ce,inc udin coun r 0 0 5.Wind Power Device d mberandStreet) El EJ 6.Hydroelectric Power Device J ❑ ® 7.Geothermal Energy Heating/Cooling Device CI State ZIP Code ) County ❑ 2.Does the buyer have a homestead in Indiana to be ❑ 121 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 add ess of residence being vacated, 1, property via e-mail?(Provide contact information including c unty: - �� below.Please see instructions for more information. n tiAV 1 ) PO y`v� Z4-d 4-3`-'Loa-O Q(.erc- �- Not available in all counties) Addr umb a d�et) /�1 �` �� 'V � �O l �1\ 26-12-06-304-002.116-028 City,StateZlP ode I County Primary property owner contact name E-mail Number License/ID/Other Number