Homestead_Dix (2)INDIANA SALwS DISCLOSURE FORM SDF ID: Pa e 2
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Ray M. Drulev Attornev No. 4759-26
Prepnrer ofthe Sala D'adosure Form Ttle
�O5 N. Church Street. PO Box 146 Law Office of Rav Drulev
Addres (Numberond Street)
E-mail
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S�P. (yn I Rnbinson Kenna Dix
Shcer 1- Name as appmrs on conveyvnce docvment Sefler 2- Name as appmrs on ronveyvnce document
_202 N. Palk 202 N. Polk
Addras (Number and Street] Addrecs (NUmber and SVeet)
_Fort Brenr.h. IN 47Fi4R Fnrt Brench 47fi4R
E-mail Tele honeNumber E-mail
Under penalties of perjury, I hereby certify that [his Sales Disclosure, to [he best af my knowledge and belief, is [rue, correct
an complete as red by law, and i prepared in accordance wi[h IC 6•1.1-5.5, "Real Property Sales Disclosure Act".
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fieorgp.R Robinson POA 2�-ab�- i i Kenna Dix �%--� 4-/�
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�F:��BUYER 5 ' GRANTEE S °:AP.P.CI@ATION?FOR•P,ROPERTX;TAX�DEDUCTIONS�=,"�IDENTIPY�AL69TEMS�THAT;APPLYt�z� �'�.: �: � ��•�
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Michael L. Dix Kenna M. Diz
Bu}rer ]- Name as appears om m�ve}ance dotvmen[ 6u}rer 2� Name as appevrs on conveyvnce docvmen!
202 N. Polk 202 N. Polk
Addras (Num6erand StreeQ Addrns (A'umberand SVeet)
�°ori Branch. IN 47648 Fort Branch. IN 47648
'iry, Smte, and LPlode
E�mail
THE SALFS DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIY DEDURIOYS FOR THIS PROPERTY. IDEh71FY ALL OF THOSE THAT APPLY.
YFS NO C09DITION I YES NO W\DITIO\
Q � 1. Will this property be the buyer's primary Q � 3. Homestead
residence? Provide complete address of primary � � 4. Solar Energy Heating/Cooling System
residence, including county:
90? N Polk ❑ Q S. Wind Power Device
Addres(Numbe�andStreeQ ❑ Q 6. Hydroelectric Power Device
Fort Branch. IN 47648 Gibson � Q 7. Geo[hermal Energy Heating/Cooling Devire
Ciry, Sm[e Z/PCOde Counry
� Q 2. Does [he buyer have a homestead in Indiana to be � � 8� �s this proper[y a residential rental proper[y?
vaca[ed for [his residence? If yes, provide ❑ ❑✓ 9. Would you like ro receive tax statemen[s for [his
complete address of residence being vacated, property via e-mail? (Provide contact in%rmation
including county: below. P(ease see insbvcdons for more in(ormation.
Nat availa6le in all counties.)
Addras(NumberandStree[J /
Ciry,Sm[eZlPlade Counry �_/�I�+���•�.��� �`
Primory properryowner con[arf name Email
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the bes[ of my knowledge and belief, is [rue, correc[
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". (Nate:
Spouse information, So ial Security and Drivers License/Other numbers are not necessary if no Homes[ead Deduction is
being filed.)e
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