HomeMy WebLinkAboutHomestead_Birch (7);�
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Preparer o(NeSala Dkdasum Form Ttle
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Addras(NUm6erand5ueet) Company
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Liry, Store, and ZIPCOde Tde➢hone Number £-mail
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Address (Number and Stree[)
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Buyv 1- Name at appears
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Shcer 2- Name as appmrs on conveyonre dwumen[
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ACdress (NUmber and StreetJ
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�, I hereby certify that [his Sales Disclosure, [o the best of my knowledge and belief, is [rue, correct
by law, and is prepared in accordance with IC 6-1.1-S.S, "Rgal Property Sales Disclosure Act".
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THE SALES DISCLOSURE iORM MAY BE USED TO APPLY FOR CERT.l1Y DEDURIOYS FOR TNIS
�� 1. Will this property be the buyer's primary �
residence? Provide complete address of primary
rp� sidence, includin county:
J`37 S�Nrl1C(JIecJ �Q.
M1ddren (Number and Sveet)
YQ.�f�'2-i2MZw `f'7ls'1� �.65�_
Ciry,Smre2lP e Counry
� 2. Does the buyer have a homes[ead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated,
induding caunty:
Address (Number md Stree[)
Ciry.SmmZIPCOde Counry
E'2 2- F�cio�r
Buyer 2- Name ar oppmrs on ronvryanre document
Addreu (Number and Strmt)
Ciry, Smlq and Z/PCOde
� 3. Homestead
THAT APPLY.
Heating/Cooling System
5. Wind Power Devire
❑ []' 6. Hydroelectric Power Device
❑ � 7. Geothermal Energy Heating/Cooling Device
� (�. 8. Is this property a residential rental property?
� �;�/ 9. Would you like to receive tax statemen[s for [his
proper[y via e-mail? (Provide contac[ informotlon
6elow. Please see ins[rucdons for more informatlon.
Not available in all cou tle
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Under penalties of perjury, t hereby certify [hat this Sales Disdosure, to the best of my knowledge and belief, is [ne, correc[
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 Deductlon is
being filed.)
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Signamrc o(Buyerl 5{qnoare o(Buyer2/Spouse
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rVnnted Legal Name o/BUyv 1 Sign Da[e (MM/OD/YF'YY�
LostSdigitto(Buyer]Driver's Smte LastSDigitroj5ocialSecuriryNumber
Lirense/ID/Other Number
Pnnted Legal Name o(Buyer 2/Spouse
Sign Date (HM/00/YYYt7
GattSdigiGSOfBUyer2/SpouseDnver's Swte LastSDigiu
Num6er Lirense/7D/OtherNumber
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