Homestead_Lacy INDIANA SALES DISCLOSURE FORM SDF ID SDO ID 1801536 Page 2
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Robert Morris Deed Specialist
Preparer of the Soles Disclosure FOIM Title
662 VVoodwardAyenue ' Title Source, Inc.
Address(Number and Street) Company
Detroit,MI 48226- 888-848-5355 robertmorris@titIesource.com
Qty.Style,and ZIPCode Telephone Number E-mail
Ralph G. Lacy Barbara S Lacy_
Seller'-Name as appears on conveyance document Seller 2-Name osajpeors a:conveyance document
625 West 650 South 625 West 650 South
Address(A'umber and Street) Address(Number and Street)
Fort Branch, IN 47648- Fort Branch, IN 47648-
Under penalties of perjury,thereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and complete as require by law,and is prepared in accordance wit At 6-1.1-5.5,"Real Pr' .erty Sales Disclosure Act".
(((id?, b 01--)/"--- ali if -- 1—.4( - I *1 z•-■ ‘e —
Signciture of Seller - 0 S, na tare af Seller
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c' ,• UYER(Sy GRANT EE(SI;:APPLICATIONYOMPROP.ERTY3 AKDEDUCTIONSIDENTIFYALLATEMSIHAT APPLY
Barbara S. Lacy /
1---Ntime as appears on conveyance document Buyer 2-Name us appears on conveyance docensps,
625 West 650 South
Address(Number and Spry) Address(Number and Street)
Fort Branch,IN 47648-
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF T11464iTIIA V..
YES NO CONDITION YES NO CONDITION °OA/r
°UN ru
0 0 1.Will this property be the buyer's primary El 0 3.Homestead ' r rt luo g,..
residence? Provide complete address of primary ii z ,. _- - -. .: ' 'eating/Cooling Systelh0/?
residence,including county:
0 ig 5.Wind Power Device
Address(Ntnnber end Sneer) n o 6. Hydroelectric Power Device
IN NOT APPLICABLE El ri
L j E_1 7.Geothermal Energy Heating/Cooling Device
Go?.Scare ZIP Code County
0 0 8. Is this property a residential rental property?
fl 0 2.Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes,provide 1_1 U 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
. .
including county: below.Please see instructions for more information.
Not available in all counties.)
Addrs(Number and Street)
71—A3—don. °co. 90J-ods
City,State ZIP Code County
Prima'y property owner contact name b-i nail