Homestead_Sunio N. PRSAItpt
parer of the Sales Disclosure Form ;Pr De
Cassie laooba j Escrow Officer
Company
1324 East Hoffer Sbeei, Kokes o, IN 46902
I. $oi f (s)/t armst(s) P I
Seaor 1 -Flame as a appears on conveyance document ' Seiler 2 -Name as appears an conveyance document 14,46,N1'
Larry E. Poweri,k.
Addnesttrnrr
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�'�WOress(number and street)
- Oil ' Gee. state. and ZIP Code 0
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USAVS
Country
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-Li-S.S.A per*oe who buaei ngly mod bi#otimos�
tr.rrphaned led or omits or isyMlas a„ry IMoi, melon naqub.d is bs provided,commits 11 lociel S Waal%
of {/�/ S/nature of Seiler yrY,Q0Q,
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at - Elate f7► a
I Phi-te1 Nave of Seises Date signed(r ldd/YYYY) *1Larry E.Powell,h
1- � . 1 1 1 R
(s)/GauurTuu(s)—APPLICATIONPsioratTY Trot O®c orris—IDENTIFY ALL THAT APPLY
Buyer 1-Name as r. appear.on corrierwe dposntnt Buyger 2-Name as It appears on conveyance doasnerit
Simplecia Sumo Seat-tae Mendoza (ND 5 p> .-.
Address(nurnorr and scree! Address(number and street)
8094 Saudi Mork&Drive (094 South Angela Drive
City, state,and ZIP Code - City, state, and ZIP Code
Fat Branch,IN 47648 fort Branch, IN 47648
Country Country
....7' NO CONDITION YES NO CONomON
❑ 1. MI th's Property br. de bole s prmary residence„ ! 3. Homestead
❑ 4. Solar Energy 14eabn9 or Caohng System
❑ 2. Dot the buyer halve a homestead to be vacated for 1 ❑ S.Wind Power Dewr
this residence?If yes,provide address. ❑ f.Hydroelectric Power Device
Address(number and street ❑ 7. Geot9emtar Energy Heating or CooIng Device
City,state.and ZIP Code / --- Y
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Under p000ldies of rwiery,II hereby certify Nat ttbla Sake Nioclosrar,bi rile best of elIl howse4 dQe lad b48144 Is trim.correct tad arrglate
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