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I\DIA\A SALES DISCLOSURE FOR�I SDF ID SDO ID 759057 Page 2
D.PREPARGR
Saman�ha Culsinqer
Prryarer oJ�he Scles Disclos�rc Form Title
I226 W. Broadway Broadway Tiile Inc.
Addra'e(Num4erondSUenJ Compony
Princeton, IN 47670.
Email
E. SELLER(S)/GRANTOR(S)
Brian K IWiz
Sriler ]- Nume os apyevn on runrnnnae derument
500 S. Center St.
Addrets (Numher and 5�
FL Branch, IN 4764&
Ci(��.Smtaand]IP e
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Under penalties of perjury, I hereby certlfy that this Sales Disdo
and completf as reqyiced�tiy law, and is prepared in accordance
, _ ,...i .i ,
f3iT:�
9uyer i
Rachel E (Atchison) Krutz
Sr/ferl � A'ume us appenrs on rmvevun�e dorumrn(
500 5. Center St.
ACdrtss (A'umber ond5vre�)
Fl Branch, IN 4764&
Ciry, Sm[e, nnA].IP Co�,
.�:�
to the best of my knowledge and belie(, is We, correct
IC 6-1.1-5.$„"�eal Property Sales Disclosure Act".
Namr as apprvrs m convrycnre dorumen[
AAdress (Number and SneetJ
Ciry.S<o�e. and ZIFCoOe
THE SALFS DISCLOSURE FORN MAY BE USEO TO APPLY FON CERTAIY DEDURIONS FOR THIS PROPERTY. IDENTIFI' ALL OF THOSE THAT APPLY.
x❑ � 1. Will chis property be the buyer's primary �
residence? Provide comple[e address of prim
residence, including county:
500 S. CENTER ST.
Address (A'um'xr and SvxtJ
Ft. Branch, IN 47648 GIBSON
[1[v. Swre zIP [oCr [omry
� � 2. Does Ihe buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address o(residence being vacated,
induding coun[y:
Address (A'umber and SveeQ
Ciry,
Counry
Q ❑ 3. Homestea
. ar Energy lieating/Cooling System
'Q Q 5. 4Vind Power Device
� Q 6. Hydroelec[ric Power Device
� Q 7. Geothermal Energy Heatlng/Cooling Device
� Q 8. Is this property a residential rental property?
� Q 9. 4Vould you like to receive [ax statements for this
property via e-mail? (Provide mnmct informotion
below. Pleose see instructions(or more information.
�'ot available in all counties.)
��- /9-/9-/oi-ctx� �?�- aa�
Under penaltles o(perjury, I hereby certify that this Sales Disclosure, to the best o(my knowledge and belief, is true, corre�t
and comple[e as required by IaH�, and is prepared in accordance with IC 64.1-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/O[her numbers are not necessary i(no Nomes[ead Deductlon is
bein[fi7ed.1%) A � .
vd�ree
Signamre nf Buyer2/Spousr
PnnrMLegnlNameofBuperZ/Spom'e SignDctelM.v/DD/1Y1'Y�
Social5ecunryNumber I.astSdigicsafBu}•er2/SpouseDriver's Smte LastSDigi[so(Sorial5ecunry
Lirense/10/OthtrNumber Number Litense/1D/OtherNUrnber