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INJOIANA .1ZALF.q DI.qrI.O.qIiRF FORM SDF ID: Paee 2
PREPARE
James A. Lyons III Closing Agent ,
Prep.rer qfde Set= Dirdarve Farm 77de
50 S. Meridian Street. Suite 600 Escrow & Title Services. LLC
Addras (Number and S4 ) Company
Indianapolis. IN 46204
E-mail
Household Financial Corporation
Sailer I - Name as appears on wnveyanee datument
SeHer2 - Name as appears on =-vq,,am,e document
961 Weigel Ave
Addr=(Nurnberandstmzt)
Flmhlrst IL 60126
Addrw(NumbtrandSneet)
E-mail I
TelephoneNumber E-mail
Under alt-es of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and c p 4 eta as req Lured by law, and is prepared in accordance with IC 6-1.1-5.5, "Rea -1 Property Sales Disclosure Act".
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Brian Brian D. Beasley
Addres (Number and Strea)
C,[ 5CZ
&mall
Tdanhane Number E-mail
THE SALES DISCLOSURE FORM MAYBE USED TO APPLY MR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDF.NMFY ALL OF THOSE THAT APPLY.
YES %'a CONDITION e CONps
❑ 1. Will this property be the buyer's primary
a
3. �Hom�este
residence? Provide complete address Of primary
/Cooling arlineiyl-leating Cool.ingSystern
Energy Heating
at E
cQunty;
CA �(d �–
C] S. Wind Power Device
CA
❑ 6. Hydroelectric Power Device
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bson
A1,01 Ci EvL (4-1 6(0 1pt
❑ 7. Geothermal Energy Heating/Cooling Device
❑ 8. Is this property a residential rental property?
0.7, St. te DF Co* County
❑ Z. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
❑ 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.)
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Add=s (Number and Svea)
my'scatezfPcode County
Primary Property m mer conzact , name mall
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as required by law, and is pr--pared in accordance with lC "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homeste?d Deduction is
bein ed.)
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