HomeMy WebLinkAboutHomestead_DebordINDIANA SALES DISCLOSURE FORDt
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Ciry, Smte, ondZlPCade
Seller 1� Name as appears on ronveyanm documm[
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Addrecs (h'um6er and Sveet)
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Company
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Sel/er 2- A'ame os appears on com�eyanre davment
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Addr�cs (NumberandSVeetJ .
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Ciry. Smte, and 2/PCOde
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Onder penalties of perju , 1 hereby certify tha[ this Sales Disclosure, [o [he bes[ of my knowledge and belief, is [rue, correct
and com e[e as qu�r by la a s 4repared in accordance with I�C 6-/1.1-5.5, "Real Proper[y Sales Disclosure Act".
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Signaorze a(Sel/er /� Sigmm/re/ o(Seller � n
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Ciry, StatG and ZIPCode
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THE SALES DISCLOSURE FORM MA4' BE USED TO APPLY FOR CERTAII DEDUCf10N5
�� 1. Will this proper[y be the buyer's prim�
residence? Provide complete address f prima
� (;� � r idence,scludin counry:
'Y�II /
�dren(fy'vmeraQl_eP l�Yl / �{( ('V ��/J:..7U/�l
T I'7 %V
Ciry.S�lPCOde Caunry.
� 2. Does [he buyer have a homes[ead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated,
�including county:
Address (Number and Svee[J
liry, SWte ZIPCOde
❑ 3.
THOSE TN.1T APPLY.
Heating/Cooling System
� � S. Wind Power Device
� � 6. Hydroelectric Power Device
❑ L� 7. Geothermal Energy Headng/Cooling Device
� � 8. Is [his property a residential rental property?
❑ �9. Would you like to receive tar statemen[s for this
property via e-mail? (Provide mntact informotron
be(aw. Please see instructions for more informatron.
Not available in all counties.)
�e��ry � t�-� q-� s- 3v3-a� �� � oa
v.;m�... �„��a.rv �W�o.m�r�rr nn„�e E-mail
Under penalties of perjury, 1 hereby cer[ify [hat this Sales Disclosure, to the best of my knowledge and belief, is [rue, wrrect
and complete as required by law, and is prepared in accordance wi[h IC 6-1.1-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse informa[ion, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduc[ion is
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LastSdigi[sofBuyer]Driver's Sm[e Las[SDigi[sof5otia15eturityNumber I LastSdigifso�Buyer2/SpauseDnver's Stnfe LastSDigi[s
License/ID/OtherNumber Num6er License/lD/O�herNumber