HomeMy WebLinkAboutHomestead_StormontFORM SDFID:
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J. Robert Kinkle
Preparer of the Sales Disdosure Form
�9 N. Hart St.. PO Box 13
'res (Number and Street)
, ceton.IN 47670
Ciry, SmtG and ZIPCode
]- M1'ome os appmrs on conveyanre document
Address (Number ond Street)
,
Title •
Hall. Partenheimer & Kinkle
Company
E�mail
Seller 2� Name as appears on canveyanre documen<
Address (Number und Streer)
Fort Branch IN 47fi4R Fort �BSranch. IN 47648
E-mail TeleOhaneNumber E-mail
Under penalties of perjury, 1 hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and co pl te a quired by law, and is prepared in accordance with IC 6-1.1-5.5 Real Property Sales Disclosure Act".
,� _ y/�c�/o ��v�.�un � nnn,'U �I-2(�-�c�
Si reof5eller �� Signamreo(Seller
Bu}•er ] - Name asappears on
Addres (Num6er ond Sb'ee[)
� 1 Branch IN 47648
'rnte, and Z(P Code
$ -%�
iHE SAIES DISCLOSURE FORM MAY BE USED TO APPLY FOH CERTAIA
�✓ � 1. Will this property be the buyer's primary
residence? Provide complete address of F
residence, induding county:
Addres (Number and Stree[)
Fort Brench IN 47648 � Gibson
City.Smte ZlP lade Counry
�� 2. Does [he buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated,
induding county:
Add�es (Num6er and Strre[J
lity. Srnte ZIP Cade Counry
Buyer 1- Name as appears on conveyvnre dacumm[
Address (Number and So-ee[J
Ciry.StatG andZlPCode
YFS NO 6
✓❑ ❑ 3.
OF THOSE THAT APPLY.
Heating/Cooling System
� Q 5. Wind Power Device
� ✓� 6. Hydroelech-ic Power Device
❑ ✓Q 7. Geothermal Energy Heating/Cooling Device
� Q✓ 8. Is this property a residential rental property?
� Q 9. Would you like to receive tax statements for [his
property via e-mail? (Provide contoct in/ormotion
below. Please see instructions for mare information.
Not availa6le in all counties.) �
o?l -�9-�9-0?o sL o0� 330 - aa
Michael L. Stortnont
Primary properry own¢r conmtt name E-mail
Under penal[ies of perjury, l hereby cerdfy tha[ this 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-S.S, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
being flled.)
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.mreofBuyer] �G ��O Signamrea/Buyer2/Spouse
�Airhool L Stnrmont -i �a� �-I
Pdn[edLegalNameojBuyernl SignDate(aM/DD/1'1'1'h PrinredLegalNameof8uyer2/Spouse SignDa[e(nrM/DD/YYY1)
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LastSdigifsofBuyer]Driver'S Sfate Las[SDigi[so� LastSdigiGSO�Buyer2/SpouseDriver's Smte LostSDigi[sofSociolSecuriry
Lirense/lD/O[herNumber � Number License/ID/OtherNumber