HomeMy WebLinkAboutHomestead_Hirsch (5)INUTANASALES DISCLOSUREFORM SDFID:
W t!�"Sr
� Address(Numberond5veetJ
�vl9�'S�•rGt�, Ln/ �i���
City.Smre. andZlPGOde
��
T��e Sves
7o r�� �r�N
Compony
TelephoneNumber E-mvil
��
�AVID R DOUGLAS MARY M. DOLIGLAS
Seller I� Name as appevrs on romryvnre drcvmmt Seller 2- Name as appears om m�veyonce daumm[
J���,s �z� 7��� s 7`z,E
Address(NumberandSVeet) Addr�'(A'umberand5veet)
�vR ,— �i/'iA.✓�i� ri✓ �7��Si 1=a,2� �3RA.✓c,�� •.� ,�/ �7� �8'
Gry_•,3 mre.andZlPCode � Ciry,Smre.ondZlPCode T
,�
Emaii Tele honeA'vmber E�mail
Under penaltles of perjury, t hereby certify that [his Sales Disclosure, to the best of my knowledge and belief, is true, correct
an�mplete�as requir�d by law, an�jis prepared in accordance with IC 6d1-S.S, "Real Proper[y Sales Disclosure Act".
]-h'ameasappearsmconvryan o
�
s(NUmberand5treet)
SaJ �7G i`�
TNE S,1LFS DISCLOSIIRE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCf ION$ FOR THIS
�� 1. 4Vi11 this property be the buyer's primary
resSdence? Provide complete address of primary
78'7���'�;i�'i� `'%�'a `�rtys.-�
�'-i�`I�''r"anc�� ��l ��c��8
�Ci .5 :eZIP ade lounry
2. Does the buyer have a homestead in Indiana to be
vaca[ed for [his residence? If yes, provide
complete address of residence being vaca[ed,
including county:
Addres (Nvm6 er and Svee[J
Ciry.SmreZIPCade lounry
Buyer 2- Name os appears an conveyvnre dacumm[
Addr� (Numbernnd Svee[J
CiN.Smte. andZlP fade
FO CO\DITIO\ �
❑ 3. Homestead
THATAPPLY.
Heabng/Cooling System
Wind Po�ver Device
❑ �- 6. Hydroelectric Power Device
❑ � 7. Geothermal Energy Heabng/Cooling Device
� � 8. Is this property a residential renfal property?
❑ � 9. Would you like to receive [ar sta[ements for [his
property via e-mail? (Provide contoct informadon
6elmv. Please see instructions far more infarmation.
Not availa6le in al( counties.)
� -i9-�9-�a ���.�39- oa�
nome
E-mail
Under penalties of perjury, I hereby cer[ify tha[ this Sales Disclosure, to [he best of my knowledge and belief, is tne, correct
and complete as required by law, and is prepared in accordance with IC 64.1-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/O[her numbers are not necessary if no Homes[ead Deduction is
Signanire o/BUyer2/Spouse
o��'��'�0 /Q
Pnn[ed Legal Name aJBuyer 2/Spouse
Sign Date (HM/DO/1'YY))
Las[Sdigi[sofBuyer7Driver's Sfare LastSDigi[sofSocial5etuntyNumber I LastSdigiGSOfBuyer2/SpouseDriver's Stnte LastSDigiCSOfSocial5eturity
License/lD/OtherNumber' Number License/ID/OtherNvmber