HomeMy WebLinkAboutHomestead_Goodman H. PREPARER "•
Preparer of the-"Sales Disclosure Form Title
KANESHA,WFISTER AGENT
Company
- Address(number and street,city,state,country,and ZIP Code)
400 ROUSER ROAD __ _ _
i SELLER(.S)/GRANTOR(S) • - __.
Seller 1-Name as it appears on conveyance document' -'Seller 2-Name as appears on conveyance document
DANIEL S SCHRIVER SHALEA-SCHRIVER
Address(number and street) Address(number and street)
307 CRESTVIEW DRIVE ' 307 CRESTVIEW DRIVE
City,state,and ZIP Code City,state,and ZIP Code
OWENSVILLE, IN,47665 OWENSVILLE,IN,47665
Country Country
USA USA
E-mail address
best of-my knowledge-and belief-Is true correct and complete as
required'by law,and le'prepar d in accordance with.IC,6 1 1-5.5.A person who knowingly and intentionally_fatsifies the Value of transferred
real property,or cunt yor fel��II es"fly formation required-to be provided,._commits a Level 5 felony::.." :� _
Signature of Seller�') SI nature of Seller
(}, ��� h'l a/Q.P., M),ru!..(. i J ) I
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
DANIEL S SCHRIVER t'1-/ 0 /' L-& SHALEA SCHRIVER i2 l OS 12O'L1
to'applyfor certain deductions.identify all of those that apply: ``
YES NO CONDITION YES NO CONDITION m
1.Will this property be the buyer's primary IRE G'i 3.Homestead o p pzi
ig. El co
residence? CI 4.Solar Energy Heating or Cooling Sy t o0 iv H
z -.4 It.'2.Does the buyer have a homestead to be vacated ( 5.Wind Power Device ry
for this residence?If yes,provide address: El IN 6.Hydroelectric Power Device A IV
Address(number and street) 1:1 (g 7.Geothermal Energy Heating or Cooli& ice V
City,state,and ZIP Code County 26-17-01-403-000.204-022
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ca
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