Homestead_SeibertForm
Ciry:
Karer K. �+or'r�ani'
Sellerl-Nameasappearsonconveymredocument �� Seller2-Nameasappmrsomm�veyanredocumen[
18 cU$ ��co �mo�
A/d�dras(NUmberandStreefJ �� J �� Address(Num6erand5[reet)
C��i�s�s�le_, s-�i �
Teleohone Number E-moil _
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
aad comple[e�as required,by law, and is prepared in accordance with IC 6-1.1-S.S, "Real Property Sales Disclosure Act".
�,i�i��e� �< ��vrm�'It
�meors
' GRi1NTEE 5 '=.AP.BL II
n ��. S�: e/�
Vomeasappairsonconveyance n[
e e �r
JumberondSq ee[J
,��aolt, iN ti�C��i
-
SignaN�e o(Seller
Buver 2- A'ame os oppevrs on tanveyunce dotumen[
Addras(NUmberandSReet)
Ciry, Smce, and ZIPCode
THE SALES DISCLOSURE FORDf MAV BE USED TO APPLV FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IOENTIFS' ALL OF THOSE THAT APPLY.
� � 1. Will [his property be the buyer's primary
residence? Provide complete address of primary
residence, including county:
1[�. 8. Pr f.�. 7� Q.
A�jeress(NumberandSbee[)
%IAIA.BSTADT, 1.v �J(o��'I G/ci.$0'J
Ciry�. Smre ZIPCode Counry
�c'i � 2. Does the buyer have a homestead in Indiana to be
F.�.�
vacated for this residence? If yes, provide
complete address of residence being vacated,
1 _ ,r i\ncluding county,
l(.'�`l- � F—�Y� U�h �u-L
�--�7�dress(yVUmberand �eetJ� J � �' �Q '�/�
� —1 1lrC�� � 4 �A C ��i.l `
Ciry. SmteZlPCOde Covnry
� �
� �
� �
■ �
� �
� �
� A
3. HomesYead
4. Solar Energy Heating/Cooling System
S. N'ind Power Device
6. Hydroelectric Power Device
7. Geothermal Ener� Heatlng/Cooling Device
8. Is this property a residential rental property?
9. Would you like to receive ta�c s[atements for Chis
property via e-mail? (Provide con[act informotion
below. Please see instrudions for more information.
Not available in all counties.)
. /_ / -0140 -lXl� /. �90� -OdZ �
Vrimarv omoem owner mnruc[ name E-mail
Under penalties of perjury, t hereby certify that this Sales Disdosure, to the best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance with IC 6Q.1-S.S. "Real Proper[y Sales Disclosure Act". (Note:
Spouse information. Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
being filed.) '
o(Bvyer]
S{qnaNre of Buye�2/Spovse
o(BUyer2/Spouse
Sign Dare (MM/D�/YYYp
LastSdigitsofBuyer2/SpouteDnver's Sm[e Las[SDigi¢oj5ocial5ecunty
Number Lirense/ID/OtherNum6er