Homestead_Herren�.
DISCLOSURE FORM
ZIPCode
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Seller?-A'ameasapptarsanconveancedocument Seller?-Nameasappearsonconve}vncedomment `f
?/44 S. �so E ����; s q� E
Address (Num6e� and SveetJ Address (Num6er ond SveetJ
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Under penalties of perjury, 1 hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and com�lete as required by law, and is prepared in accordance wi[t}.!C 6-1.1•S.S, Real Property Sales Disclosure Act".
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THE SdLES DISCLOSURE FORM MA1' BE USED TO APPLY FOR CERTAIN DEDUCf1045 FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
..__ .... ...............� I YFS �0 CONDITION _
�I ❑ 1. �Nill this property be the buyer's primary
re 'dence? Provide complete address of primary
� r ' en�g,ir�;u�1i g�tounty
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e s(A'um6er ee[ ( �
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Cig. Sm:= Z/P lode Coung�
�� 2. Does the buyer have a homestead in Indiana to be
vacaced for this residence? If yes, provide
complete address of residence being vacated,
including county:
Address (ffumber and S[reet)
Ciqt Sm:e Z/PCode
Covnry
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❑ 3. Homestead
4. Solar Energy Heating/Cooling Sys[em
S. Wind Power Device
6. Hydroelectric Power Device
7. Geothermal Energy Heating/Cooling Device
8. Is this property a residential rental propern�?
9. 4Vould you like to receive tax statements for this
property via e-mail? (Provide contactinjormotion
6elow. Please see instructions for more in%rmation.
Not available in all counties.)
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cdm�rv nrnnem oumer tonmrt name E-mail
Under penalties o( perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
��d ��.,,.,�PrP a� �rnuired bv law. and is oreoared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure AcC'. (Note:
Last 5 digits o�Buyer 1 Driver's
License/ID/Other Number