Homestead_Miller (11)1\D41NA SALES DISCLOSURE FOIL�1 SDF ID 262009-1000433
D.�PREP�IRER� .�t`.�.' � ;a � _ E., r�a,, , � �„�Y
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TIANA L KOHLER TITLE CLERK
�Frpme� oJthe Salc Disclotwe Form Title
84 E. MAIN ST., STE. 102
Addreu (A'umbn md Srnt) Compam�
PLAINFIELD,IN 46168
SECRETARY OF HUD SECRETARY OF HOUSING AND URBAN
Seffo -A'ame m appem� on mmr�nnce
40 MARIETTA ST.
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Telephane,YUmber E-mail
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ATLANTA,GA 30303
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7nder penalties of perjury, 1 hereby certi(y that Ihis Sales Disclosure, to [he best of my kno�•ledge and belief, is true, correct and
omplete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Properh� Sales Disclosure Act".
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Date (,4AUDD/5'Y}'YJ PnmMA'mne oj5dla Sign Qate (MAS/DD/Y}YYJ
JORDAN A MILLER
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29 A RALEIGH DR.
EVANSVILLE,IN 47715
Cim. Smre, and LPCade
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"HE SALES UISCLOSURE FORJI JIAI' BE USED TO APPL]' FOR CEFt7'�Afl
appems on rom�n�nnce
Addreu (,YUmber end Sneell
r, I. Will this pmperty be the buyers primary residence? Provide ompfere I r; 3. Homa
address of primary residence, inctudine county: r. 4. Solar
507 N. CHURCH ST.
Addrets (A'umbo and 4reu)
FT. BR4NCH, IN 47648
Cip•, Smre, and7JPCade
Gihson
Caunrv
r. 2. Dces the buyer have a homestead ro be vacated for this residence? If
yes, pro��de complete address of residence vacating, induding counry:
dddru.� (.�'umber md S�re<q
Cin'. Smre. mdLPCade Counrc
FOR
Sysrem
r 5. Wind Power De��ce
r 6. Hydrcelectric Power Device
� 7. Geothermal Energy HeatinJCooling Device
r 8. Is this propeny a residential rental property?
r: 9. Would you like to recieve tac stacements for this property ��a
e-mail? (Provide conracr informarron below. Please see the
instructions jor more info rion. .\'o+ ovoikb(e in a(! rountiu.)
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Priman'nmttrtrox'nermruaa name E-,
unaer penatties m per�uq•, � nereby cernq� that m�s sa�es uac�osure, ro me oest m mr �:no�r�eage aoa beiiet, is true, correct antl comp�ete as
required by la�r, and is prepared in accordance e�i[h IC 6-1.1-5.5, "Real Propem� Sales Disclosure AcY'. (Note: Spouse Intormation, Social Securih�
and Driver's Licenselother rtumbers are not necessaq• ff no Homestead Deduction is being filed.)
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