Er. saae. SALES DISCLOSURE FORM Stare ;"'ot'rrt 4602! (R |'nrsuant to accortling to by CY The telephone numbers ottlie parties on this form are conlidcnlial /tr l2(tlt} [IS!9t9(t II) l"l Unique ID (,'nunty Year Date: 02! 9X20 sag: .. 5. 6. 't'a.r liittirn; to 1' Parcel Number: l7 2- Approx. 540 CR. 1200 North iv. .. . v. [17 Odon, IN 47562 (710? 949 7. Legal 41Section Township 5 N, Range 6 West, Davtess County, IN. . It transfer of real property interest for valuahie consideration. 2. Buyer is an adjacent property owner. 3. Vacant land. If 4. Exchange for other real property ("Trade"). 5- Saller Paid }70l11t3- (Provide the Herr: J2.) [7 6. Change planned in the primary use of the property? in in Toliite r'rent 3.) 7. Existence of family or business relationship between buyer and setter. 8. Land contract. Contract term (YY): 0 Land Contract Date l' 9. Personal property included in transfer. in .rpect'at' in I-'obit: limit 10. Physical changes to property between March I and date of in in ?krbte Hart: 3.) l. Partial irr.s'pec.'irr? in Table Cirem 3.) l_ 12. Easements or1'ight--ot'--way grants. l7. l3. Document for compulsory transactions as a resutt of foreclosure or express threat of foreclosure, divorce, court order, judginent, condemnation, or probate. 14. Documents iiwolvittg the partition of land between tenants in common,joint tenants, or tenants by the enlirct'y. l7 15. 'I'ranst"er to a charity, not<> _l077z:> ?cm Esta gem Iirldress {Nmiihermiri {Nm;riliei'miri . /4 Store, and (Iity, mm' 'e.'epl'ionc mnlier 'leiephomr Nmii.bei' INIJIANA SALES FORM 11): Page 2 Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and coniplet:e ired by la ml is pi-epa;-ed in accordance with IC "Real Property Sales Disdosure Sigiiri id M42 Printed' Nru :of.S'el'lei' Siyii Drite _s fiuim $4 mi In/ii' A - CIIZN -- Name as (spire rs on coiwe_ mice (locum ml {Ow Li. I .firldi'es.s'{ - IE5, .mdZH' I In 1-. Buyer' 2 - Nmne as on can riociinieiit /irirliess' (Ni.-mlier mm' Sti'ee.'.) (Iity, .S'mte, ZIP Code Ni.-mlier if-inaii SALES FUIIM Mm' BE USED TO FUR FOR THIS !lJ?EN'l'lF'i' Al'l'i.Y. N0 c. YES NO 3. Homestead 1. Will this property be the buyer's primary 4-. Solar Energy I-leating Cooling System residence? Provide complete address of primary 1 ence, 'nclu ing county: FEES N('scan Vt City, Si.'ri.tc Corie 1 fimmty 2. Does the buyer have a hoinestead in Indiana to be vacated for this residence? lfyes, provide complete address oi" residence being vacated, including county: 5. Wind Power Device 6. I-lydroelectric Power Device 7. Geothermal liinergy l--Ieating/Cooling Device 8. is this property a residential rental property'? Would you like to receive tax statements for this property via e--mail? (Prrivide Contact below. Please see instructions for more informciI:i'on. Not evaflable in all c0untie.s'.) l3l:ll:il]l:li:lD~ Xi dd ress mm' .S'ti'ee?) pr'{ipci'ly riiwier Home Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best ofmy knowledge and belief, is true, correct and complete as required by law, and is prepared in accordance with IC 6--1.1--S.S, "Real Property Sales Disclosure Act". [Note: Spouse information, Social Sccu/yy and Driver's License/Other numbers are not necessary if no Homestead Deduction is /2:75: Sigii at we I Si'giirimi'r: \nL,i i of {Jule {MM/mi/i'l'i'l'} i.eg(ii Nfililff .S'.flqii l')oie Mist. 5 o'i'gi'Ls of Last 5 l)fgit's Last 5 digits offluyer 2/Sproiise State Last 5 ofSor.'i'cil Number' Nuinber INDIANA SALES DISCLOSURES FORM ID I us.n~.a.m :7 Page 2 if-4' 'Eli LA Acl. Pi'cpai'ei' of Hit.' $fllr."S l)isci'osm'e i"m'm 'i"itla 13:1 Slegifl 21 rlrirass {Nani lid!' and (.'oinpriiu' IN 3n-~3229v 095?? Nuinliei' jg. ,m,f;I State, and Elli' Corie .S'eHer 2 - Name as appears on .S'c.'ler 1 - Name til' iippeiirs on convqyiince riiJ late i~h,r~r. Son . ?nme and .S'ii'eet} our! Sirei.-I) 475511 City, and Zii'Coa'e City, .S'?oic, amber 'J"eiepiionr.= Number Under penalties ofperjury, I hereby certify that this Sales Disclosure, to the best ofmy 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". Nomi: o[Seiici' Sig,-ii Date Printed Name "on Date 7 II Bliyerl -- Name as op,oears on conreyamc document Buyer 2 - Name as appear'; on coiiveyanire document {Niimlier and Street) Atlciress {Number and City, State, a :1 Code City. and ZIP Code Naniber 'l"eiephoiie Number gm" ,1 IJISCLOSIIRIE I"0llM 1313 USED TO FOR CERTAIN ALL 01-' YES NO YES NO 3. Homestead 4-. Solar linergy i-Ieating/Cooling System 5. Wind Power Device 1. Will this property be the buyer's primary residence? Provide complete address of primary residence, including county: 6. Power Device 7. Geothermal Energy Heating/Cooling Device 8. 18 this property a residential rental property'? 9. Would you like to receive tax statements for this property via e--mail? (Provide canto ct information below. Please See i'nsLraCti'onsfoi' more information. Not available in all coun ties.) /1 ridress {Nuinber and I 7ft)', State ZIP Code County 2. Does the buyer have a homestead in Indiana to be vacated for this residence? If yes, provide complete address of residence being vacated, including county: UDEIDUDD DEJDDEJDEJ A iidross {Nurnher aria' .S'irei:t) ity, State Zii' Corie County i"riinai_y property owner contact Home 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 ifno Homestead Deduction is being filed.) .S'igiiature ofi3ayei'2/Spa use of Bayer} Legal ofBuy.e,r' I Date Legal Name offlayer Sigii Do re Last 5 d:'g:'ts 1 Driver": State Last 5 Digits ofSor:i'ai Security Number Last 55 digs' is of Ba yer pa use i)ri'ver's .S'tate Lost 5 Digits ofSociai .S'ecariLy Number Nuinber License/ii)/Other Number 3 (71 Page INDIANA SALES FORM ID: in ca L415. /Vi" i'i'-'Ji'mi'ei' afilie Sales l)l$L' osurr: l"arm I 'iZI'?'ic _l?~iIl AM. 309. Q: Company i if lira' City, State, aiirl ZIP Code Amam&e,ukodnafi? .S'elici' - Name as a,npears on coiiveyrmce rlocamcni Seller' 2 - Name as appears on can i.-tjraace riacamcni sma .'1clo'ross imiliei' and Sii'ei:r) Ekkmgim q7SMl Mk City, State, and ZIP Code State, Carlo if-mail Nl.'ii'i.l.if.'l" Telcplioao Under penalties ofperjury, I hereby certify that this Sales Disclosure, to the best ofrny knowledge and belief, is true, correct and complete as required by law, and is prepared in accordance with IC "Real Property Sales Disclosure Act". 5'igiiriiui'e of.S'eil'er .S'ignai.m'e of.S'eller Name of Seller' Sign: Date Name of.S'ell'ci' Si_gii Date City, State, and Zil' Code City, State, and Zil' Corie 'l'elephom2 Number' fz'-mail' 'i'ele,rJhaiIe Number MAY USED TO i'il'l'i.i' FOR CF.il'l'AlN FOR THIS lf)f3N'l'lFl' ALL OF was NO res iiayerl - Name as appears on conveyaiicc document Buyer 2 - Name as appears on coiivcyancc document A rirlress {Nam bar and Stree.'.j A ritlress {Nam bar' an (i S?'i'ect} 3. Homestead Solar Energy Heating/Cooling System 5. Wind Power Device 6. Hydroelectric Power Device 7. Geothermal ljlnergy Heating/Cooling Device 8. is this property :1 residential rental property? 9. Would you like to receive tax statements for this property Via e--mail? (Provide Contact information below. Please see instructions for more information. Not available in all counties.) 1. Will this property be the buyer's primary residence? Provide complete address ofprimary residence, including county: an (I .S'ti'cet) City, State Zii' Corie Colin ty [j 2. Does the buyer have a homestead in Indiana to be vacated for this residence? If yes, provide complete address of residence being vacated, including county: Nam her an a' .S'Ii'er:t} City, State Zll' Code County i'i'anaiy pi'opei'ty owner name Under penalties certify that this Sales Disclosure, to the best ofrny 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 ifno Homestead Deduction is being filed.) Signai.ui'e afl3ayci'2/Spouse 5 .S'ignatiirc ofllayarl Legal Nam offiuycr Sign Do to Legal Nmm: ofiluyer Sign Date Last 5 digits of Ba yer I Driver's State Last 5 Digits of Social Security Number Last 5 digits ofBuyei' 2/Spouse Driver's State Last 5 Digits afsaciai Security Number License/ID/Otiier Number Liceiise/H)/Otliei' Naailzaer Page 3 INDIANA SALES DISCLOSURE FORM SD17 ID: 4 and stamp the form hefore sentling to the auditor: :nusl'ue1'ify and colnpleie 1 through 1. Pmperg: 2. A If 3. Al'1rnproucr:1ent 4. Value 5. AV Tom.' 6. Property 7. Nefghborhoorl 8, 9. Acreage C.'as.9 Code Code .. LPL Koo H1700 loo (90.5 cm eggs 333 10. ldentifypilysicai changes to properly inetween March I and ms 1 N0 dme .11. Is form completed? State saies fee requimd? 13. Date of sale or)/Wm: I - to 32 ~10 14-. Date form received -. 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