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Kimberly A. Lewis Office Manag�r .�
Prepurerofthr.iale Dktlomre Form iitle
i w. Broadwa
(Numberand5veet)
Prinratc�n, TN 47670
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David W Bruce
Seller 1- Name os appmrs on ronvrymve dxvmmt
305 N. Church St.
Addrcss (Number and So-eetJ
Ft. Branch, IN 47648
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Broadway Title, Inc.
Company
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Se/fe� 2- Nome as appears on canveyanre dorummt
Address (Number and Strttl)
Smt4 and ZIPCode
Under penal[ies of perjury, I hereby certify [ha[ this Sales Disclosure, [o the bes[ of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance with IC 6-1.1-S.S, "Real Property Sales Disclosure Ac[".
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SignamrcoJSdfer I Signamrco/Seller
�t�r:.f V. 3i•s� c o9• 30 - LeD9
1 � h'ome as apptars
Name as appenrs on ronvryvnce dxvmm[
Addrm (h'umber ar.d 5[rre[) Addrest (Nvmber and SvretJ
Prinr.atnn TN 47670
[iry, 5wre, and ZIP [ode Ci.y, Smt4 and 21PCode
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Tele honeNvmber
THE SALFS DISCLOSURE FOR�N MAY BE USHU TO APPLY FOR CEItTA1V �EDUCfI0Y5 FOR THIS PROPHRT'. IDENTIiY dLL OF THOSE THAT APPLY.
[� ❑ 1. Wiil this property be Ihe buyer's primary I
residence? Provide complete address of primary
residence, including county:
305 N. Church St.
Addrm (Nvmbrr and Streec)
Ft. Branch, IN 47648 Gibson
Ciry, Sm[e ZIPCade Counry
❑ ❑ 2. Does [he buyer have a homes[ead in Indiana to be
vacated for this residence? If yes, provide
comple[e address of residence being vacated,
including county:
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[iry.SmreZIPCaEe
❑ 3. Homestead
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Hea[ing/Cooling System
S. 4Vind Po�ver Device
6. Hydroelectric Power Device
7.GeothermalEnergy Heating/Cooling Device .
8. Is this property a residential rental property?
9. Would you like to receive tax statemencs for thfs
property via e-mail? (Provide contact informotion
below. Please see instructions%ar more in%rmation.
Not available in all counties.)
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Under penalties o( perjury, I hereby certify that this Sales Disdosure, to the best of my knowledge and belief, is true, correct
and comple[e as required by law, and is prepared in accordance wi[h IC 6-1.1-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse informayim� Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
be4�g filed.) � �
( 00/Y1'YY)
Signa.vreo(BUyer2/Spouse
Pnn;ed Legal Name oJBvyw 2/Spause
Da[ejNM/DD/YYYYJ
ID�iver's Smte Las[SDigitta(Social5ecunryNum6er I LastSdigitsofBuyer2/SpouseDriver's Stare LasrSDigirsojSocial5eruriry
nber Num6er Lirense/fD/OtherNum6er