Homestead_KuesterID:
Rav M Drulev Attomev No 4759-26
�i Preparua(theSa/aDittlmnreForm T4e
�o rv. �nurcn a�reec r.0 aox � ati Law Office of Rav M Druley
Address (Num6erand Street) Company
Fort Brench. IN 47648
Ciry, Smte, ondTJPGode Tefephone Number E-mail
FreA J Kuacter Martha J K pctPr
Selfu 1- Name ar app�rs on canveyvue dxvmmt Seller 2- Name as appmrs on ronveynnce dxumenr
42 E 600 C 770� F 600 C
Addres (Nvmber and Street) Addrers (Number ond Streef)
_Fort Rranch IN 47fi4A Fort Brannh IN 47R48
('iry, Sm[e, andTlPCode liry, Smte, ondTJPCade
_
E�moll Tele honeNumber E-mail
Under penalties of perjury, l hereby certify that this Sales Disclosure, [o the best of my knowledge and belief, is true, correc[
and com te a� ' ed w, and is pr pared in accordance with IC 6-1.1-5.5, "Real Prop r[y Sales Disclosure Ac[".
' ' " �7�.cz� � 5� /�,u-e���
Sjgna reo/ dle� (f 7 / Signamreoj5eller - (I� ' �7 �j
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mnveyvncedotumml
andZlPCade
THE SALFS DISCLOSURE iORM MAY BE USED TO APPLY FOR CERTAIN
❑✓ ❑ 1. Will [his property be the buyer's prim
residence? Provide comple[e address
residence, including tounty:
1624 E 600 S
Addr�s (Num6er and 5trret)
Fort Branch.IN 47648 Gibson
Ciry, Smte ZIPCode Counry
� Q✓ 2. Does the buyer have a homestead in indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated,
induding wunty:
Addr�s (Number and5treet
�
Ciry, 5[areLPCOde
Under penal[ies of p ' . � ' �
and wmplete as reqi . - - ,• "
,:,� �.�� . .
Spouse information, - ;
being filed.)
sr��aa ole�n 'C ' ' `. . '
�
1624 E 600 S
Addras(NumberandSVeeQ
IUEVTIFY ALLap41tOSE TNAT APPLY.
❑✓ ❑ 3.
. ar nergyHearing/CoolingSystem
� Q S. Wind Power Device
❑ ❑✓ 6. Hydroelectric Power Device
❑ ❑✓ 7. Geo[hermal Energy Heating/Cooling Device
� �✓ 8. Is [his proper[y a residential renWl property?
❑ Q✓ 9. Would you like to receive tax sW[ements for this
property via e-mail? (Provrde contact informa[ion
below. Please see instrucdons for more in%rmation.
— � Not availa6le in a!l coundes.J
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License/ID/Other Number
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E�mall
[o the best of my knowledge and belief, is true, correct
IC 6•1.1-5.5, "Real Property Sales Disclosure Act". (Note:
ers are not necessary if no Homestead Deduction is
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ure ofBUyer2/Spouse
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iLegvlNameo/
�digioo�Buyer2/SpouseDriver'S SCate LastSDigi[sofSocialSecuriry
e� License/ID/OrherNumber
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