Homestead_Miller.:�
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IADIANA SALES DISCLOSURE FORDi SDF ID: Pa e Z R
'D.:FREP.ARER - ; .: ; • ; _ .. _ . . • , > -
Jenny Sherrill Cusiomer Service R=o.
Preporerofthe Sale D'¢dosvre Fortn Title
�6525 Easi 82nd Street Suite 110 Statewide Title Comoanv. Inc.
Address(Numberand5veec) Lompom�
Indiana�olis. IN 46250
um6rr E-mnil
sE: SELL•ER S ' GRANTOR S ` � ,- " - - ' ' " ?
Fadaral Natinna� Mnrt�gP Accociatinn
SeOer 1- Name at appears om m�ve�vnce dacument Seller 2� h'ame as appmrz on canvevonre doctimen�
14991 flallac Parkway S'ta inon
Address(NumberandSVeetJ Addres(Numberand5vee[)
rlallac TX 7595d
Citv, Smte, and ZIPCode Cin�, Smte, ondZlP lode
E�moi! TelenhoneNumber E-mail
Unde ies of perjury, I hereby certifi� that [his Sales Disclosure, to the best of my knowledge and belief, is hve, correct
a comp e as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Propert}• Sales Disclosure Act",
S�g of5eller I Signamreof5elier
' r
PdnredNameo75eller Sian tef.s/oo/rrrr� PdnredA'ameo(Selfer SianDarefHn/DD/F'YY1'I
-'F�BU ' GRAN ,EE S �-AP.FCIGA FO +P.ROPERT,Y�TAX�DEDUCTIONS-IDENTIF.YACti:1TEMS.THAT'AP,P.LY � � > � -;
�i
Buyerl-Nameasappeurson nveyunadocumen: Bwer?�Nameasappearzonmmevonredocumen[
203 weJr Nicci,�Mr
Addre,s (Num6er and Svee[) Addres (Nomberand Sveet)
FoRt BR�acN � lN 4�6`JS
� Liqt Smu. and ZIP Lode Lin•, Smre. andZlPCOde
Email Tele honeNumber E-moil
THE SALE$ DISCIASURE FORM A1A1' 6E USED TO APPLY FOR CERTAI\ DEDULTIONS FOR THIS PROPERTS'. IDEhTIF1' ALL OF THOSE THAT APPLY.
1'FS NO CO\DRION I YFS NO CONDITION
[� � 1. Will this property be [he buyer's primary ❑ 3. Homes[ead
residence? Provide complete address of primary � � 4. Solar Energy Hearing/Cooling System
residence, includin� counq�: 5. Wind Power Device
Z 0 3 W Er7 :�'�«ll1 MI �
Addres(A'umberavd5ueeq ❑ � 6. Hydroelectric Power Device
F ortt B RAN� „� IN Y 7 6 4 8 G� B1oN � � 7, Geothermal Ener� Heating/Cooling Device
CirytSmte Cade launry
� � 2. Does [he buyer have a homestead in Indiana to be � �$� !s this property a residential rentat property?
vacated for this residence? If yes, provide ❑ 9. Would you like to receive tax statemenu for this
comple[e address of residence bein� vacated, propercy via e-mail? (Provide contac[ informopon
including county: �/� befow. Please see tnstrucdons for more information.
Not available in all coundes.)
Addrvs(h'umberanCSbeet) A' / ^
�7 /i' c�/s+'—/S -/.3 -h���/orY1 6� S� �.b
Cig�.SwreZfPCade Counry
Priman�pmnemawner[onmttname E-mai!
Under penalties of perjury, t hereby certif}� [hat this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance with IC 6-11-S.S, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are no[ necessary if no Homes[ead Deduction is
being�G�„
% � h.Jti+
—� gnaaire ofBuverl Signature of8uyer2/Spouse
�'NRiJtoPNER r1/Lt eR OZ'0`I -zoll
�v Ain¢d6eoalNomeofBwer] . SlgnDare(ww/on/Yn'1) PrinredLegalNameof8vyer2/Spouse SignDate�rs/oo/nvr)
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Las[Sdigifso(8uverlDnver's Sfnte Las[SDigiLSO(Social5ecuriNNum6er Lastidit�i[so�Buver2/SpauseDriver's Srale Las[SDigiao%Sociol5ecuriN
Gicense/lD/Ofh_rNum6er Num6er License%fD/OrherNum6er