Homestead_StodghillSALES
DisdosureForm
SReet)
SDF ID:
TITLE CLERK
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REGIONAL LAND TITLE
E-mvil
_ . . _ ".+� i' . - . '
RORFRT S CTC1I�C;HII � �
Seller 7� Nome as appears on ronveyanre documm[
4f14 W I OC� IST STREET
Address(NUmberand5treetJ �
Il Il IA A STOnGHILI
SvJler 2� Name as appeors on ronveyanre document
404 W I OC:I IST STREET
Addr¢s(NumberondSveet)
FORT BRANf H IN 47Fx1A fORT RRANCH IN 47fi48
Cip; SmtG and LPCode Ciry, Smfe ond LPCode
E-mail
Under nal ' of p rj � t�re yd��a[ this Sales Disclosure. to [he best of my�knowledge and belief, is true. correct
and coi�o as re re b(la pared in accordance�th I� 64.7�.5, "F�eal,�roge�fSa}e�s Disclosure Ac[".
Addras
TNE SALFS DISCLOSURE FORM MAY BE OSHD TO APPLY FOR CERTAIY �HDUCfI0V5
Q � 1. Will this property be [he buyer's primary
residence? Provide complete address of F
residence, in[luding county:
Addras (A'umber ond SReet)
FORT BRANCH IN 47648
liry, Smre7JPCad< Counry
� ✓� 2. Does the buyer have a homes[ead in Indiana [o be
vacated for [his residence? If yes, provide
complete address of residence being vatated,
including county:
Add�gs(Num6erand5nee[)
[iq•.Srure
Lounry
Buyer 2- Nome as appmrs on conveyance do<vmen�
Addrgs(NumberandStree[)
Ciry, SwtG and ZIPCode
Q � 3. H
APPLY.
Energy Heacing/Cooling System
� ❑J S. Wind Power Device
� Q 6. Hydroelectric Power Device
� Q✓ 7. Geo[hermal Ener� Heating/Cooling Device
� Q 8. Is this property a residen[ial rental property?
� �✓ 9. Would you like to receive tax sta[ements for this
property via e-mail? (Provide contactinformotion
6elaw. Please see instructions for more informadon.
Not ava/�ly�le in all counties.)
�0-/�/3-�.3-(J110. U�G-oolG
MICHAEL SCOTT STODGHILL NA
vrl.��rv�ro�ertvawnermnmctname E�mail
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance wi[h IC 6-1.1-S.S, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security a d Driver's License/Other numbers are not necessary if no Homestead Deducdon is
bein file �i��'�
Sjgnamreo/Buyerl Sgna[ureofBuyer2/Spouse
i..... _. ..,...r. .._.....,, ,,. . -��—�/—/�
${gn Da[e (HM/OD/YYYt)
Pnnted Legal A'ame o(Buyer 2/Spouse
S(qn Da[e (HH/OD/YYYYj
Las[Sdigi6ofBuyer7Driver't Smre 5ocialSecuriryNum6er I LastSdigicso�8uyer2/SpouseDnver's Sra[e Las[SDigitso%Social5ecuriry
Lirense/lD/OtherNum6er Num6er License/(D/OtherNumber