State Form 46021 - Sales Disclosure Form - Indiana Page 2
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12INDIANA SALES DISCLOSURE FORM
SDF ID:_________________________________
Page 2
D. PREPARER
______________________________________________________________________________________________
______________________________________________________________________________________________
Preparer of the Sales Disclosure Form
Title
______________________________________________________________________________________________
______________________________________________________________________________________________
Address (Number and Street)
Company
______________________________________________________________________________________________
______________________________________________________________________________________________
City, State, and ZIP Code
Telephone Number
E-mail
E. SELLER(S)/GRANTOR(S)
______________________________________________________________________________________________
______________________________________________________________________________________________
Seller 1 - Name as appears on conveyance document
Seller 2 - Name as appears on conveyance document
______________________________________________________________________________________________
______________________________________________________________________________________________
Address (Number and Street)
Address (Number and Street)
______________________________________________________________________________________________
______________________________________________________________________________________________
City, State, and ZIP Code
City, State, and ZIP Code
______________________________________________________________________________________________
______________________________________________________________________________________________
Telephone Number
E-mail
Telephone Number
E-mail
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".
______________________________________________________________________________________________
______________________________________________________________________________________________
Signature of Seller
Signature of Seller
______________________________________________________________________________________________
______________________________________________________________________________________________
Printed Name of Seller
Sign Date
Printed Name of Seller
Sign Date
(MM/DD/YYYY)
(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) – APPLICATION FOR DEDUCTIONS AND CREDITS – IDENTIFY ALL ITEMS THAT APPLY
______________________________________________________________________________________________
______________________________________________________________________________________________
Buyer 1 - Name as appears on conveyance document
Buyer 2 - Name as appears on conveyance document
______________________________________________________________________________________________
______________________________________________________________________________________________
Address (Number and Street)
Address (Number and Street)
______________________________________________________________________________________________
______________________________________________________________________________________________
City, State, and ZIP Code
City, State, and ZIP Code
______________________________________________________________________________________________
______________________________________________________________________________________________
Telephone Number
E-mail
Telephone Number
E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES
NO
CONDITION
YES
NO
CONDITION
1. Will this property be the buyer's primary
3. Homestead
residence? Provide complete address of primary
4. Solar Energy Heating/Cooling System
residence, including county:
5. Wind Power Device
______________________________________________________________________________________________
6. Hydroelectric Power Device
Address (Number and Street)
______________________________________________________________________________________________
7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code
County
Deductions.
2. Does the buyer have a homestead to be vacated for
8. Is this property a residential rental property?
this residence? If yes, provide complete address of
residence vacating, including county:
______________________________________________________________________________________________
Address (Number and Street)
______________________________________________________________________________________________
City, State ZIP Code
County
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".
______________________________________________________________________________________________
______________________________________________________________________________________________
Signature of Buyer1
Signature of Buyer2
______________________________________________________________________________________________
______________________________________________________________________________________________
Printed Name of Buyer 1
Sign Date
Printed Name of Buyer 2
Sign Date
(MM/DD/YYYY)
(MM/DD/YYYY)
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