Homestead_Hayes •
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H.,PiREPARER '''' ,'",,;, •,-"' '
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Preparer of the Sales Disclosure Form Title
Brian K. Mahoney Attorney
I Company
Address(number and street,city,state,country,and ZIP Code)
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822 E Main Street Petersburg, IN 47567
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I .SELLEk(S)/GRANTOR(S) .;' ' • .,;',,,••,'--- .' - .
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Patricia Ann Kaiser
I Ad ress(number and street) n$ Address(number and street)
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City,Star,:and ZILCodro 063D City,State,and ZIP Code
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United States
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Email Address
beatcif rfrimowledgei'andvbetlef„isttriiie,icorrect,anditdmllet0As
i.renyiredbYla*4nditlpinpOied;Itilebbofdab0*tillIO.64::05:5I*;fiere.bi*o:.ki*Win.g(paburriltenti6nallylfalsrfiesithe,vilUe•otifarliforred.
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Signature of Seller .
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1 P n ed ame of Seller Date Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
Patricia Ann Kaiser 5 I IS i as
j, BUYEA(S)/GRANTEE(5),;—ArOPEICktitiN,kik:PkbOEkifYi TAX DEDUCTI6N- T S ,ibENTIFY ALL - 1 \ISIE:(5
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as it appears on conveyance docu
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i Eric Hayes
Address(number and street) Address(number and street) • . u-,
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23 S 0 AI Ale A 1)411")/45 6'11 l• c-.1
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i City,State,and ZIP Code City,State,and ZIP Code co E
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Country Country mmi 1 Z
United States
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Email Address Telepiirmiillimber
Niii4iMilc.ii604:1;744,::oe:Aatop:IP.10P10001.FOri*rff.dY:',140..490J5i.Opplylfoe.,:'w.lain.004.00w:410.qtifyi011 of t.130§,R344,aPPV.:i.
YES NO CONDITION Ir. NO CONDITION
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. / 1.Will this property be the buyer's primary 0 3.Homestead
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residence? 0 C) 4.Solar Energy Heating or Cooling System
V ,--, 2.Does the buyer have a homestead to be vacated 0 2 5.Wind Power Device •
' for this residence?If yes,provide address: 0 2 6.Hydroelectric Power Device
Address(number and street) n• _ 0 2 7.Geothermal Energy Heating or Cooling Device
g35 0 .4) itneclicumte_s 614 Va..).
City,State,and Z1P Code County
40-02" 4-1 ),4- c60 , o 5-c03
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