HomeMy WebLinkAboutHomestead_HollisFORM
Rav M. Drulev Attorney No. 4759-26
Preparer ofNe Salc Diidosure Form Ttle
Law Office of Rav Drulev
Nortnan Shor.kley
Seller 1- h'ome as appevrs on cwveyvnce documen[
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Selier 2- Name as oppevrs on ronvryanre doavmmt
Address (A'umber and StreetJ
Ciry Sta[e, andZlPCode
Under penalties of perjury, I hereby certify that [his Sales Disdosure, to the bes[ of my knowledge and belief, is true, correct
and complete as requir� b„y law� a�d is prepared in accordance wi[h IC 6-1.1-5.5, "Real Property Sales Disclosure Ac[".
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(NumberandSVtttJ
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FORM MAY BE USED TO APPLY FOR CERTAIN DEDURIO,�'S i0R
� 1. Will this property be the buyer's primary
residence? Provide complete address of �
vreZIP[ode - � - / Counry
� 2. Does [he buyer have a homes[ead in Indiana [o be
vacated for this residence? If yes, provide
complete address of residence 6eing vacated,
_ includingcounry: n
Caunry
SignamreofSefler
Buyer I- A'ame os oppevrs on romtyvnte do[vmen[
Add�as (Numberand Stree[J
City, Smte, and ZIPCode
THAT APPLY.
� U 4. Solar Energy Heating/Cooling System
� Q 5. Wind Power Device
� �✓ 6. Hydroelectric Power Device
�❑ ❑✓ 7. Geothermal Energy Heating/Cooling Device
� �✓ 8. Is this property a residential rental property?
❑ ❑✓ 9. Would you like [o receive tax statements for this
proper[y via e-mail? (Provide contact informa[ion
belaw. Please see instrucnans/or more informanon.
Not availa6le in all caundes.)
So?� /e�/.3_�SLUOd.%�%���
Rimarv vnxmaumer cenmtt name E-mail
Under penaities of perjury, t hereby certify [hat this Sales Disclosure, to the bes[ of my knowledge and belief, is true, correc[
and complete as required by law, and is prepared in accordance with IC 6-1.1-S.S, "Real Property Sales Disclosure Act". (No[e:
Spouse information, Social Security and Drivers License/Other numbers are no[ necessary if no Homestead Deduction is
being filed.)
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5' reof6ycrl _ i . , S{gnamrea(Buyer2/Spause
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Latt 5 Digiu o�Social Serurity Num6er
PrintedLegalNumea(Buyeri/Spouse 5(gnDate(MM/DD/YYII]
LastSdigitsofBuyer2/SpouseDnver's Smte LastSDigitsa�SorialSecuriry
Number Lirense/lD/OtherNum6er