Homestead_DillII�DIANA SALES DISCLOSURE FORM SDF ID: Pa e Z
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Rav M Drulev Attomev No 4759-26
Preparo ofNe Sale Disclmvre Form 7itle
�5 N. Church Street P.O. Box 146 Law Office of Rav M Drulev
Address (Numberand Street) Company
Fort Branch IN 47648
Email
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�E£SELLERS°.GRAN;TORS t��'�`t.i�'��-��i�tiv�p.u:."$-�k'��rs:ti=�����:�'�.�4��`'-��,�'s!:: �?.,�£s.Y.ii-���nG;r�
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Seller 1- Name as appears on ronveyvnce document 54Ier I- Name as appears an conveyvnce dotummt
57'i W fi5� S
Addras (Numberand Streeq Addrw (Number and Street)
Fort Rranrh IN 47648
E-moil iele honeNumber f-mail
Under penalties of perjury, I hereby certify [ha[ this Sales Disclomre, to the best of my knowledge and belief, is true, correct
and c mple[e as re„ qu,jyqd by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
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�5lgnarureo/Selle � SignaaueoJSelfer
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PnntedNamea Seller Si nDate�MM n PohtedNameo Selfer Si �DO[C MM �
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;EFBUYER 8', " TEE S t„AP,P,I:ICATION;FOR�P.ROPERTY;TAX<DEDUCTIONS_;IDENTIF,Y=AliL ITEMSiTHAT,APPLY�at,z�.w?tk�� �...:..� '
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v pearsonronveynnredocvmm[ Buyer2-Nameasappearsonronveyanredocument
509 N. Polk Street
Addras(Num6erand5tree[J Addres(Num6erandSVeet)
Fort Branch IN 47648
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E-mail Tele honeNumber E-mail
THESALFSDISCLOSUREFOM7MAYBEUSEDTOAPPLYFORCERTAI\DEDUCTIONSFORTHISPROPERTY.ID TNATAPPLY.
YES NO CONDRIOY I NO [OYDRIO.�'
�✓ � 1. Will this proper[y be the buyer's primary �✓ ❑ 3. Homestead
residence? Provide complete address of prim 4. Solar Ener Hea ' a ing System
residence, including county:
Sna N Polk �treet ❑ Q S. Wind Power Device
Addr�s(A'umberandSbeeQ ❑ Q✓ 6. Hydroelectric Power Device
Fort Brench IN 47648 Gibson � � 7. Geothermal Energy Heating/Cooling Device
Ciry, Sm[e LP lode Caunry
� Q✓ 2. Does [he buyer have a homestead in Indiana to be � ❑� $� �s this property a residential rental property?
vacated for this residence? If yes, provide ❑ ❑ 9. Would you like to receive tax statements for [his
complete address of residence being vacated, property via e-mail? (Provide rontact informadon
including county: 6elow. Please see instrucdans for more informa[ion.
Not available in all coundes.) �po �y ,$"� (y a
Address (A'um6er and StreerJ
a�-i�-i�--vo/-aov./,s'9_ o�6
Ciry, SmceTJP lade Counry
Pr(maryWOpertyawnermnmc[name E-mail
Under penal[ies of perjury, I hereby certify [hat [his Sales Disclosure, [o the 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 Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homes[ead Deduction is
bein�d.-��
Signamreofev}er7 L Signatureo(Buyer2/Spouse
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Pdnted Legvl Nome o/BUyw 1 �. S,�ll Da[¢ (MM/DD/YY1'Y) Printed 6ega1 Name ofBuyel2/Spouse 5{qn Dace (wu/o0/YY1'F)
LastSdigi6o(Buyer2/SpouseDnver's Smte Las[SDigitsofSociai5ecuriry
6irense/ID/OtherNumber Number License/lD/OrherNum6er