Homestead_Smith (8)Reparera(Ne Sa/es Dittlosure Farm
r _,; ;_. .`. _.-. .._,-�.i.'...
Closino Coordinator
Title
Bosse Tiile Comoanv
Sellerl-Na asap rsonronveyvncedavment Seller2-Nameatuppevrsonconveyanredorument
o�SiU �h�'eQt.t 1�'r. ,2,�w Chc�Pau �..
Add m6erand5vre�) �dr�(Num6erandSvretJ
P' .���t q8373 � �yau��, wA aga��
Under penalties of perjury, 1 hereby cer[ify [hat this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and cy1' mfllqte � reqw by law, and is prepared in accordance with IC 1.1-5.5, "Real Property�s Disclosure Act".
%1 � ✓! J ( _ /l,�.Ts+� iF^'Y L �- f
�Ignamrto(Sel(er � . gn o� �
' Y J�
�.� _LN `+�7�i o
��{
�N 4�7�a7�
THE SALFS DISCLOSURE iORM MAY BE USEO TO APPLY FOR CERTAI4 UEDUL710N5 FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
.Q � 1. Will [his property be [he buyer's primary �
residence? Provide complete address of primary
res' en e, in�l din�county:
�`(� � �A i �L,iy\.
Ad (Num rand�5'uee� i � ���� ^ ��'M -
1%L��J� �� V/ —
�Ory. mreZlPlode Counry
� 2. Does the buyer have a homestead in Indiana to be
vacared for this residence? If yes, provide
compie[e address of residence being vacated,
IIw• mc ding co qty:
8 � nz .�T
Add�s(�'v^m6er N;l) �� ����� ��
1 N
r� r�
Ciry. Smle Z/P Cade Counry
� 3.
Energy Heating/Cooling System
5. Wind Power Device
� �' 6. Hydroeleccric Power Device
❑ � 7. Geo[hermal Energy Heating/Cooling Device
� � 8. Is this property a residentlal renql property?
❑ � 9. Would you like Co receive taY sfatements for [his
property via e-mail? (Provrde contact informadon
6elow. Please see instrucdons jor more informa[ion.
Not availa6le in all counties.J
o?G-/� 3�-.3ao-aoa. o99-oa�
Rimarvnmoermoumermnmr[name E-mail
Under penalties of perjury, l hereby certi(y [hat this Sales Disclosure, to the best of my knowledge and belief, is [rue, torrec[
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, Social5ecurity and Driver's License/O[her num�ers are no[ necessary if no Homestead Deduction is
beipg filed.) - - - , „ � n . n � n�
��l �ignMUreaJ6v��erZ/Spouse - ,p