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Seller ]- A'ame os appmrs om m�veyance documen[
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E-mail
Nome at apPears an conveyance document
Address(Nom6erond5bee[) I Addres(Numberond5veet)
Ciry, SmtG and ZIPCode
Ciry, Srnte, andZlPCade
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, corred
and complete as required by law, and is prepared in accordance with IC 6-1.1-S.S, "Real Property Sales Disclosure Ac[".
Sgnomreof5eller
TAX
i - name a:
THE SALES DISCLOSURE FORM MAY BE USEU TO APPLY FOR CERTAI\ DEDURIOtiS FOR THIS
YES NO CO3DRIOY
�❑ 1. Will this property be the buyer's primary
residence? Provide complete address of F
Ciry,SmteZlPlode � - Counry
❑ �2. Does [he buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vaca[ed,
induding county:
Address (A'umber and StreeQ
[iry, Smce ZIP [ode
5(qna[ure o(Selfer
Addras (A'umber ond Stree[J
��-r �raxxk, f i �.i 4'�l�4cS
APPLY.
❑ 3. Homestead
�( _ 4. Solar eating/Cooling System
5. Wind Power Device
❑ 6. Hydroelectric Power Device
❑ 7. Geothermal Energy Heating/Cooling Device
❑ 8. Is this proper[y a residential rental property?
❑ 9. Would you like to receive [ax statements for [his
property via e-mail? (Provide conto[t information
6elow. Please see ins[ructionsfor more infarmadon.
Not available in oll counties.J
a, (�-�4r -Z4 Zdzc�o y�� -oa �
Primarv oranerN owner ronmct name E-mail
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Under penal[ies of perjury, l hereby certify that this Sales Disclosure, [o the bes[ of my knowledge and belief, is [rue, correct
and complete as required by law, and is prepared in accordance wi[h IC 6•1.1-S.S, "Real Proper[y Sales Disclosure Act". (No[e:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
bein�filed.l
(MM/OD/IYYY)
LaslSdigiao(BuyertDriver's Smte LastSDigi[sa(Social5ecuriryNum6er
License/lD/Other Num6er
I�wnc��n,
5(gnature o(Buyer2/Spouse n /+�
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Pn'ntedLegalNameafBuyer2/Spouse 5(qnDote(MM/00/YYY17
LastSdigi6o�Buyer2/SpouseDriver's Sta[e Las[SDigiGSO�Social5ecunry
Num6er Licente/lD/OrherNum6er