Homestead_Vazquez INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.-PREPARER -._
Kimberly A. Racey Settlement Agent
Preparer of the Sales Disclosure Form Title
606 Main Street Dubois County Title Co., Inc.
- Address(Number and Street)
City,State,and ZIP Code Telephone Number E-mail
E,,S.ELLEil(S)/GRANTOR(S)-' - -- - - - -
Vada Ferry
II
7INajas appears onaleia,57ent Seller 2-Name as appears on conveyance document
1ddber tr Address(Number and Street)
afthf?IJ,'f* l/
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
apd complete required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller Signature of Seller
Vada Ferry 11/3/2020
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name(Seller 41: Sign Date(MM/DD/YYYY)
F.13UYER(S)/GRANTEE(S) -APPLICATION FOR_PR'OPERTY`TAXDEDUCTIONS .IDENTIFY ALL ITEMS THA :AP .V- -
Hector Vazquez - -4 ki n
Buyer 1-Name as app arson con a e document Buyer 2-Name as appears on conveyance document NO -
/07 S. lk 1/1
�4 dress(N ber an Street) 77 Address(Number and Street) /��j�j,, 202n
/ /N C vi� GAB v` �- (/
FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
❑ 1.Will this property be the buyer's primary ❑ 3.Homestead
residence? Provide complete address of primary ❑ 4.Solar Energy Heating/Cooling System
residence,including county:
A T„IfrO� �/, ❑ 5.Wind Power Device
Address(Number and treet) -Kr��,� ) /'T� /� ❑ V . ydroelectric Power Device
04ki4i% r1� (6o
f 3 .1JV 7/ ( ?&$iI ❑ geothermal Energy Heating/Cooling Device
City,State ZIP'ode County
❑ R5 2.Does the buyer have a homestead in Indiana to be illIs 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)
a(3--N -ts'-\ol --000. 81t3-oo + .
City,State ZIP Code County
Primary property owner contact name E-mail
Number License/ID/Other Number