Homestead_Clore,.,.
Liry, SmtG and Z1P Code
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M�i.�� H. �.LDf�E
Selfer 1- Nome ar a pmrs am m�veyvnce docvmmt
3043 LaeEE��1E
Addrgs (Number and Stree[)
FvANSUi�_I � � tn1, ti�a5
��-C�- ( CCb ° tYC7
� ( 57 Ac�., !c��1�1'. �' �%�i �l°
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Telephane Number E-mail
Seller 2- Nome as oppmrs on conveyanre document
Address (Number and Sbee[)
Clry, Sm[e and ZIP lode
E�mail � TefephoneNUmber E-mail
Under penal[ies of perjury, l hereby certify [ha[ [his Sales Disdosure, to [he best of my knowledge and belief, is [rue, correct
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
I-Name
-/8�09
y�� v g
TNE SALFS DISCLOSIIRE FORM MAY BE USHD TO APPLY FOR CEHTAIY DEDUCf10N5 FOR
�❑ 1. Will this proper[y be [he buyer's primary
residence? Provide complete address of F
residence, inclydingcpunty:
❑ � 2. Does [he buyer have a homestead in Indiana to be
vacated For [his residence? If yes, provide
complete address of residence being vaca[ed,
including county:
Addras (NUmber ond Sveet)
Counry
s��an�.�
Buyer I- Nume ar apymrs om m�veyance Eocvment
Address (Number and SVre[)
Ciry, Smt4 andZlPCode
APPLY.
YFS NO
� ❑ 3. Homes[ea�
❑ }� 4. Solar Ener at�ng/Cooling System
�nd Power Device
❑ �, 6. Hydroelectric Power Device
❑ �(J 7. Geothermal Energy Heating/Cooling Device
❑ � 8. Is this property a residen[ial rental property?
❑ 9. Would you like to receive tax statements for this
property via e-mail? (Provide rontact informa[ion
below. Please see instructions for mare information.
Not availa6le in all rountles.J
�G-i9-�9-a�3-aoia�� oa�
conmtt nome
Under penal[ies of perjury, 1 hereby certify [ha[ [his Sales Disclosure, to [he best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance wi[h IC 6-1.1•5.5, "Real Proper[y Sales Disclosure Act". (Note:
Spouse information, Social Security and Drivers License/Other numbers are not necessary if no Homes[ead Deduction is
being �file�d.)
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��aN� � _ _ � � � 5(qnamreo�BUyer2/Spouse
SgnDate(MM/oD/YYY1� � %in[edLegalNamea(8uye,2/Spovse
Da[¢ (MM/DD/YYYt)
LostSdigitsojBuyer]Driver's Stnte LastSDigitsofSocial5eruriryNum6er I Las[Sd(qitso%Buyer2/SpouseDriver's Smce Las[SDigitsofSocial5erunry
License/lD/OtherNumber Num6er License/!D/OlherNum6er