Homestead_ObermeierFORM
S�AN
I�t G_ c� S' 1—f � ���,�ji'J �/ .
.tECrm mbavc�5treetJ
' H er P r` V t f 1 F �-f.l ��75
o�y, smm o�a vv c,a�
ne� Q
�/Jl'� h' PZ- � I `r�
Cam:=ny
� .
idtyhone No-m6n E-moil
SeOCr 2- Name cs oppmrs an ror.vryvr.ce tloccmm[
Al1ra`(NvmboanlSbe�t) ..
u.y, sr��,,�e nvcoe.
Under peualties ofperjury, 1 hereby certi(y itat this Sales Disdosure, [o the bes[ of my Fmowledge and belief, is hve, correct
and somylete as rep�yred bp iaw, and is prepared in accordance with 1C 6-1.1-5.5, "Reai Property Sales Disclosure Act".
� 'I, � . �. . /-J�, .,_ . �
I .ngnamrrolShcer
�
rn�ryron.rCCa•.r.m[
T
SALES DISCIASVRE FORM NAY eE USEb TO APPIY �OR �ItTA1N DmUR10N5 FOA TNIS PROPERTY. IDENiIiY ALL OT THOSE TXAT AGPLY.
� U 1. Will this property be the buyer's primary
residence? Provide complete address of primary
A���e�sC n, ind in coun��ry:
!r cmDerandS ac)
� • nC�n "T� �{"1Ll�R L 'L�sc>r�
Gry,SmsZIPCOCe ' Lotary
✓[Y ❑ 2. Does the buyer have a homestead in lodiana to be
vacated for Nis residence? Ifyes, provide
complete address of residence being vacated,
�ncjuding c ty�
�YIV12 �
e. >�.,eu��es�e«�
�'• nc►^ � �i�1�48 -Slibse�►'1
Gry.Smtr 21PCoGe Covn.y
�
�
■
�
�
❑�y
LJ
�
Q
�
3. Homestead .
4. Solar Energy Headng/Cooling System
5. Wind Power Device
6. Hydroelectric Power Device
7. Geothermal Energy Heating/Cooling Device
8. Is this property a residenoal rental property?
9. Woutd you like to receive tax statemenu for this
property via e-mail? (Provide contoct informafion
below. Please see instructlons for more informanon.
Not ovailoble in alI counties.)
ownn
Under penalties of perjury, ] hereby eertify tha[this Sales Disclosure, to the best of my Imowledge and belief, is hve, correct
and complete as required by law, and is prepared in accordance with IC 6•1.1-5.5, "Rea! Property Sales Disclosure AcC. [Note:
Spouse information, Social5ecuriry and Driver's License/Other numbers are not necessary ifno Homestead Deduction is
�being file r� '� _
�� ��� � d�l .�,��A/Y'�.(�
«eJBuy I 5 non�r o Bu e routt �.�y
� ( � �1P✓ [N �!r � �i
PrinmOLegolNCm.eo(8�yer]
umber_ Lat:Sd'�q�oJBuyerl/SpovseDriveri 5[cu LostSDigiaof5xia15ecvriry
, Licrose/fD/ONrrNumber ,YUmber Li:ense/ID/0[herNum�er