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H. PREPARER
Preparer of the Sales Disclosure Form Title
Britany Bradshaw Agent
Company
Address(number and street,city,state,country,and ZIP Code)
226 W Broadway, Princeton, IN, USA, 47670
I. SELLERS)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
William Riley
Address(number and street) Address(number and street)
223 Division St
City,state,and ZIP Code City,state,and ZIP Code
Oakland City, IN 47660
Country Country
USA
E-mail address
, ( )
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete as
required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony. .
Signatur o 'eller Signature of Seller
r -1
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
William Riley a- ,
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY
E-mail address
E-mail address
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
0 1 1.Will this property be the buyer's primary lii O 3. Homestead
residence? O &1 4.Solar Energy Heating or Cooling System
O 2. Does the buyer have a homestead to be vacated O IlJ 5.Wind Power Device
for this residence?If yes, provide address: O WI 6. Hydroelectric Power Device
Address(number and street) O 10 7. Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County
26-ly- IS -10 g -000 . 2 01 -o 01-- .