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iNDL11VAS.LLES DISCLOSURE FORM1t
Preparero(:heSal�D'uclofu:eFar:n Ti:le � �
�?CZ/��� S'l�'ee�` 3.w.�C L30'l �.�tn�..-� Y�'�l�e �pr�ntes
�d:at(Nu�5era.-�d5aeetJ -� Compan�
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Seiier 1- Nam.�r appe�rs om m�veyvnm dccvnm[
io��� �. 4C� ��
Addresr (Nu.rSer and Stree[)
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SeOer Z- Name as appevrs m mnveyvn¢
Addre's (Number and StreetJ
Ci.y, Smte, and LP CaCe
Under penaldes of perjury, I hereby cerdfy that this Sales Disdosure, to [he best of my tmowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance «�th IC 6-1.1-S.S, "Real Property Sales Disdosure Act".
�Buyo 1� A'o.^e es appmrs an convryonce docvmen[ �
---�—.q c5o �
- Addrcsr(Numberand5treec)
�y�}� rc�,ne,%, , � A� 4'
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TAE SALFS OISCLOSURE FOILN MAY BE USED TO APPLY FOR
Sigmmre o(Shcer
L^.r�v? - Name at appears on convrycnce doc�men:
Addrers (Nvmber and StrmtJ
Ciry, S�:e, and LP Coce '
FOR THIS PROPERTY. IDEhTIFY ALL OF THOSE THAT APPLY.
❑ 1. Wil] this properry be the buyer's primary
residence? Providz comple[e address o: primary
� residence, including county:
.� 4.�� �a.
Ciry,S eZ1PGde Cavnry
❑ 2. Does the bcyer have a homestead in [ndiana to be
vacated for this residence? If yes, pro�ide
complete address of residence being vacated,
?.
[� ❑ 3. Homestead
. r nergy Heating/Cooling SyYem
� [�' S. Wind Power Device
❑ [� 6. Hydroelec�ic Power De�zce -
❑ L,N� 7. Geothermal Energy Hea5ng/Cooling Device
❑ � 8. Is :his prooery a resideatial rental property?
❑ �9. Would you like to reteive tax statements for this
properry via e-mail? (Provide contoct informotion
6elalv. Please see instr-uc*ionsfor more injor.naaon.
Notavaifa6le in all counpes.)
7 `�i'I'X�/"Q J�, ��lil'1�' -
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Under penalties of perjury, I hereby cerdfy that this Sales Disdosure, to the best of my Imowledge and belief, is true, correct
and complete as required by la�v, and is prepared in ac�ordance �vith IC 6-1.1-S.S, "Real Property Sales Disdosure Act". (VOte:
Spouse informadon, Social Securiry and Driver's License/O[her numbers are oot necessary if no Homestead Deductioo is
heing filedJ � , � - � �
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Sigaa[v: e o(9uyer2/Spause
?nn:ed Leyal Nome afdcyv 2/Spouse
Sig : 9a[e (HH/DD/YYY�
yNum6e: I Las:SdieitsofBvye,-2/SpovseDnver'r Swre Las.SDigi[sof5ocio15acun.y
)�i=nVUmber .. � Number License/fD/GcSerNum5er