Homestead_Coleman (3)\
ti
INDIANA SALP DISCLOSURE FORM SDF ID: Pa e 2
�:D.�P,RE'FA�.'ERi`'��.�''p�a`�'tt i.� - rt�'..�'...;:� - �`'. x - =rv:r c .�.-� ->_ _
"-.• � x"_-� c .�f ='c3 _ -:2� � � �
Rav M. Drulev Attornev No. 4759-26
Preparer o(the Sala Disdosvre Farm 114e
505 N. Church Street P.O. Box 146 Law Office of Rav M. Drulev
Addres(NUmberandStreeQ Company
Fort Branch. IN 47648
;EiSELLER S' GRANTOR S - �'ti;�. , �-r,. " - � .'-,�',�, j" : ��r '�'-
(:had A Th�mf�snn KaI�,S Thomnc�n
Sefler I- Nome as appears an ronveyonce documen[ Seller 2- Nome os appears am m�veyvnce docvmmt
2779 W Colum6ia Est 2974 W Col�mhia Fct
Addres (Numberand Sveet) Addrevs (Num6er and Stree[)
Princeton IN 47670 Princwtnn IN 47670
E-moil
Under penalties of perjury, l hereby certify tha[ this Sales Disdosure, to the best of my knowledge and belief, is [rue, correct
and co% �I� as r u/i,r�ed b w, and is re ared in accordance w�t�h /I�,,6n-1.�1-5.5,f "Real Pro e Sales Disclosure Act".
l //.tc%�9lY� ��s�/'l--"r�P �C(/�/U �d �%� � ,t!—�
Sign e Shcer �namreo I/er I
Chad A Thomnson JulK29 2010 KPllv S Tomosnn July 99. 2010
PnnredN Si ODOC¢(MH D PrintedNomeo SNfer Si lIDOL¢ NM n
� YER S GRANTE ''�AP,PtICATION`F.OR`FROP.ERTtYTA ' �� � Y:AIL'ITEMS;THAT"AP,FL•YF'- Att rr''-��:°di.` �'•��
tvnH. Imn nr F.CI n
1-Namea onve}nncedocummt Buyer2-Namearappearsonm eyvncedocumm[
QO North 111
Address (Numberand StreetJ�-�— Addrgs (Number ond Street)
Patoka.IN 47666 Pafnka IN 47666
Ciry, Smre, andTJPCade lity, Sm[e, and ZIPCOde
E-mvil Tele honeNumbei E-mail
THESALESDISCLOSUREFORMMAY6EI15EDTOAPPLVFORCERTAI,YDEDUC�IONSFORTHIS IFYALLOFTNOSETHATAPPLY.
YES NO C09DITION 10 CONOITIOR
Q � 1. Will this property be [he buyer's primary ❑✓ ❑ 3. Homestead
residence? Provide �omple[e address of primary , ea[ing/Cooling System
residence, including county:
9974 W Coh mbia Eci J❑ ❑✓ S. Wind Power Device
Address(NumberandStree[) ❑ ❑✓ 6. Hydroelectric Power Device
Princeton IN 47670 Gibson � Q 7. Geothermal Energy Hea[ing/Cooling Device
Ciry, Smte ZIPCade Counry
�✓ � 2. Does [he buyer have a homestead in Indiana to be � ❑� 8• �s this property a residential renWl property?
vacated for this residence? If yes, provide ❑ Q✓ 9. Would you like to receive tare sta[emen[s for this
complete address of residence being vacated, property via e-mail? (Provide contact informadon
including county: below. Please see instrucdons for more information.
1115 E 500 North Notavaila6le in all counties.)
Addras (A'um6er and Stree[J
Patoka. IN 47666 Gibson �G _ �i_,��oa - aG.�- i�� a� �
Ciry. Smre Z1PCode Counry
Pnmaryproperryowne�ranmr[name E-mall
Under penalties of perjury, I hereby certify that [his Sales Disclosure, to the best of my knowledge and belief, is true, correct
and comple[e as required by law, and is prepared in accordance with IC 6-11-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse informatlon, Social Security and Drivers License/O(her numbers are not necessary if no Homestead Deducdon is
be(i�j filed.)�� /%p t�
o Xly�,�/✓ � ///tl',�/l�v� �� � \ao0n u .••`
SignaNre ofBuy+eil 5{qnaNre ofBuy¢r2/Spouse
�tavcn H Mloman _ Ju�y 29 i010 c�...�.� C I`..iom�n Ju[y i9 i010
Num6er Liceue/lD/OrherNum6er
��