Homestead_MelchiorSDF ID:
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Neparer of fhe Sola Disdasure Form Ttle
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Sel/er 1- Name ea �......._ "' '__"'_"_'" '_ _'_""
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Addras (Number and Streel)
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Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correc[
and c� e as required by law, and is prepared in accordance with I -11 .5, "_ Re . per[y Sales Disclosure Ad".
SignqtveofSel��� _ , S�(qnotureofSelfer � �
THE SALES DBCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIY DHDUCfI0Y5 FOR TNIS PROPERTY. IUENTIFY ALL OF THOSE THAT APPLY.
(� ❑ 1. Will this property be [he buyer's primary
residence? Provide complete address of primary
residence, including county:
�la�l C. I�c�nk�oo�ll.Jo�...i
1addr�s (Number and Stree[�
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Ciry, Smte ZIPCode Counry
�. ❑ 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vaca[ed,
including county:
/�7 Al_ E��.F� ST
Ad ras(Numberand5veet)
��a �� �� ��c�3 5
C/ry, Smte7JPCOde Counry
� ❑ 3. Homestead
❑ � 4. Solar Energy Heating/Cooling Sys[em
❑ � S. Wind Power Device
❑ � 6. Hydroelectric Power Device
❑ � 7. Geothermal Ener� Heating/Cooling Device
❑ Q 8. Is this property a residen[ial rental property?
❑ � 9. Would you like to receive ta�c statements for this
property via e-mail? (Provide contactinformation
6elow. Please see instruccions jor more injormadon.
Nof available in all coundes.)
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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 prepared in accordance wi[h IC 6-1.1-S.S, "Real Proper[y Sales Disclosure Act". (Note:
Spouse informatian, Social Security and Drivers License/O[her numb rs are not necessary if n Hom s[ead Deduction is
bemg led.) i �/��� � �
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Sig awreofBUyerl S{g amreo��
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