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• INDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2.
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Rav M. Drulev Attomev No. 4759-26
Preparer o(Ne SalaOisdosure Form Title
505 N. Church Street PO Box 146 Law Office of Rav Drulev
Addrm (Numbv ond Svee!) [ampo�y �
Fort Branch. IN 47648
E mail
aE."SEL'I:ER $ `.GR'ANT.OIi S �'...�'u-_`�. i..a'f'-,-f�_.'. .c,°�{�rt,:�" t�,.^`' _�.�: :- �:. * .�:<< �c.�'...�... . .:.�.cis s�- ..+n^--�^C '"-�:,
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Mattha Rrinhart
Selfe� I- Name as oppears on conveynnce docvmen[ Seller 2- Nome as appears on ronveynnce doavmen[
PO Aox 11
Addras(M1'umbvand5treel) ' Addrns(Numberand5trre[)
Cynthiana IN 47612
Ciry,Smte,andLPlode ' C(ry,5mte.andZlPCode
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E-mail Tele honeNumber E�mail
Under penal[ies of perjury, t hereby certify that this Sales Disclosure, to the bes[ of my knowledge and belief, is true, correct
and complett s req 'red by aw, and 's p red in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
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namr /Sel/er 5(qnaNreo(Seller
➢n'ntedNameo SAier Si n00t! HM o PnntedNameo Stller Si �Da[¢ HM o
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Buyer - easappeanonronveynncedxument Bu r2- sappearsomm�veynnredo[ument
302 S. Cenier 301 E. Strain Street
Address (NUmberand Street) Address (Num6er ond So-ee[)
Fort Branch IN 47648 Fort Branch.IN 47648
Ciry, Smte, and LPlade Ciry, Smte, and ZIPCode
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E-mail
THE SALFS DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAI\ OEDUGTIOYS i0R THIS PROPERTY. IDE\TIiY ALL OF TNOSE THAT APPLY.
VFS 80 COYDRI08 YES NO CONDIii .
�✓ � 1. Will this property be the buyer's primary Q � 3. Homeste
residence? Provide comple[e address of prima .ry � 4. o ar Energy Heating/Cooling Sys[em
residence, including county:
302 S. Center ❑ Q✓ S. Wind Power Device
Addr�s(A'umberand5tree[J ❑ Q 6. Hydroelectric Power Device
Fort Branch. IN 47648 Gibson � � 7, Geo[hermal Energy Hea[ing/Cooling Device
Ciry, Smre LPCode Counry
� �✓ 2. Does the buyer have a homestead in indiana to be � ❑`� $• �s [his property a residential rental property?
vaca[ed for [his residence? If yes, provide ❑ ❑✓ 9• Would you like to receive tax s[atements for th�s
comple[e address of residence being vacated, property via e-mail? (Provide mn[act informadon
including county: 6elow. Please see instructions%r more informahon.
Not available in all coundes.)
Addras (Hvmber and Street)
in-Iq-1�1-10 1 OGb ��{�6
Ciry.StareZlVCode counry
Ydmaryp�ope�tyawnerronmrtname E-mail
Under penal[ies of perjury, l hereby certify tha[ [his Sales Disdosure, to the best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance with IC 6-1.1- 5, "Real �per[y Sales Disclosure Act". (NOte:
Spouse information, Social Security and Driver's License/Other numbers ar ot necess �f no Homes[ead Deducdon is
beingfinled.) /
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License/!D/OtherNum6er Num6er Gicense/ID/OrherNum6er