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INDIANA SALES DISCLOSURE FORINI SDFID SDO ID 471785
Page 2.
'6. PREPAREW-
Chandra Kepley Title
P,epaer of the Sales Disclosure For. ride
& 0 E Main Street Ste 102 Contract Processing and Title
4WAddness(Nu.ba.ndSa,eet)
-E.,SEl]LER(S) `GRANTORS )-'tz7 Ztf
'A_ .5
Secretary Of HUD Seueaty of Housing & Urban Development
Seller I - Name as appears an convmninre document
Sella 2 - Name as appears on canqvance docam,ru
40 Marietta Street
Address (Number and Street)
Address (Number and Street)
Atlanta, GA 30303-
E-mail
Telqn have Number E-mail
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 with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Signatureaf5efter Stinaareofseller
F -APPLICATION FOR PRO;E`RTY�TA& I )UCTIONS- IDENTIFY ALL ITEMS THAT APPLY-
,?qayle Dierlam
r com-eyan m document
Buyer 2- Home as appears on arnevanm document
6301 W CR 100 S
Address (Number and Siiat)
Address (Number and Street)
Petersburg, IN 47567-
MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR TH 15 PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION ES NO CONDITION
1. Will this property be the buyer's primary
g EE) 3. Homestead
residence? Provide complete address of pri
❑ E] 4. Solar En ating/Cooling System
residence, including county:
_E]
. Wind Pow
5er Device
5 W Pow
❑ F1 6. Hydroelectric Power Device
Address (Number and Stmt)
IN ADAMS
❑ El 7, Geothermal Energy Heating/Cooling Device
EJ E] 8. is this property a residential rental property?
City, Stme ZIP Cod, Cann"•
❑ 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
E ❑ 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.)
7 - /O /- 6150, 79'0 -M
Address andStreo)
ss
_3-,�
Chandra Kepley ckepley@mntmcttide.com
C,V,Star,ZIPCode County
Primary property owner contact name E-mail
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 with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
being riled.)
Signature of8yer] Signature oilBuyet-215pouse
, Sign Date th(M/VD/1111) Printed LelmINameafBa3,21Sp.. Sig. Date (ieM1VD1YYM
WedLi,9a1N..i,.fftaTaI
IN
Last 5 digits B
al" Buyer lDruTr's Store Last 5 Digits ofSochil security Number Last 5digiaciluyer21spouseDriver's State Lost 5 Digits of Social Senintr
License /ID /Other Number Number LicenselID10therNumber