State Form 46021 - Sales Disclosure Form Page 2
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13INDIANA 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
Email
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
Email
Telephone Number
Email
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 61.15.5, "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 PROPERTY TAX DEDUCTIONS– 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
Email
Telephone Number
Email
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
8. Is this property a residential rental property?
2. Does the buyer have a homestead in Indiana to be
9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide
property via e‐mail? (Provide contact information
complete address of residence being vacated,
below. Please see instructions for more information.
including county:
Not available in all counties.)
______________________________________________________________________________________________
Address (Number and Street)
______________________________________________________________________________________________
____________________________________________________________________________________________
City, State ZIP Code
County
Primary property owner contact name Email
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 61.15.5, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver’s License/Other numbers are not necessary if no Homestead Deduction is
being filed.)
______________________________________________________________________________________________
______________________________________________________________________________________________
Signature of Buyer1
Signature of Buyer2/Spouse
______________________________________________________________________________________________
______________________________________________________________________________________________
Printed Legal Name of Buyer 1
Sign Date
Printed Legal Name of Buyer 2/Spouse Sign Date
(MM/DD/YYYY)
(MM/DD/YYYY)
______________________________________________________________________________________________
______________________________________________________________________________________________
Last 5 digits of Buyer 1 Driver’s State Last 5 Digits of Social Security Number
Last 5 digits of Buyer 2/Spouse Driver’s State Last 5 Digits of Social Security
License/ID/Other Number
Number License/ID/Other Number
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