Homestead_Curl (2) INDIANA SALES DISCLOSURE FORM SDF ID:, 9 2 Page 2
D.PREPARER
DANIEL A.MOON .ATTORNEY_--.-._--^—
Pre;rarer tit the Sales Disclosure Form ..... Title
116 S. MAIN$T. REEVES.COCHREN&.MOON ---...----
Add,evs(Number and Street)
E.SELLER(S)/GRANTOR(S) P14
COUNTRY AYRFv INC .- — — —' — ,r.on rn+, etir 4.1
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Seller I-Name a,appe rs onconveyance dncuntenr Seller 2 Nome ns nplu•. veyont i
44.V
Address(Number and Street) Address(Number sail Strre ie)?..?
Hauhstadt IN 47639
-
City,Stole,and ZIP Cole City,State,and%N'Code O
N c02
812/457-8838 E-mail
'l'elep ,me Number. __ email -.--._ Telephone Number .-_._,� i
Unde penalties of erj ry I •
here certify that this Sales Disclosure,to the best of my knowledge a , - f,is true,correct
• and mplet a i y law nc� prepared in accordance with IC 6-1.1-S.5,"Real Property Sales t sclosure Act".
aloe of of Seller / Sepnnt t Seller
DAVIL F CAR iREL /,a -a '•/
Panted Nome ufSeller _.-- ---- Sion Bate(Mtt/hb/YYYY) Printed Name of Seller Slip.Date(M14/111/VYYYI
F.BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
Marsha F.Curl
Buyer I Nurnc•u>up),curs or+.anveyun,r Jot on+rnt Buyer 7-Name a..appeory on conveyumr. Joe unnent
9969 Clearview Drive
Address(Number and Street) Address(Number and Street)
Haubstadt.IN 47639
RE.IISF.D TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY AI.I.OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
Q ❑ 1.Will this property be the buyer's primary n ❑ 3.Homestead
residence? Provide complete address of primary ❑ 0 4.Solar Energy lieating/Cooling System
residence,including county: 0 Q ,,•Wind Power Device
- - ❑ 06.Hydroelectric Power Device
Address(Number and Street)
❑ Q 7.Geothermal Energy Heating/Cooling Device
City,Sate 7.11'Cole County ri Q 6.Is this property a residential rental property?
Q ❑ 2.Does the buyer have a homestead in Indiana to be ❑ Ellq Would you like to receive tax statements for this
vacated for this residence? if yes,provide
complete address of residence being vacated, property via e-mail?(Provide contact information
below. Please see instructions for more information.
including county: Not available in all counties.)
9969 Clearview Drive
(Nenadt.Ic
Address rand SStreet)err) /��
Haub.s 47639 GIBBON — Z mod.. -
OLD-a0�� L �� -Ci �..JL/Q
7
City,Stntr ZIP Code CooneyPrimary property metier contact name E-mail
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
license/ID/Other Number
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