Homestead_Lawrence:;JDIANA SALES DISCLOSURE FORM SDF ID: ' Pa e 2
�. �r--�� � . _ � � ��`-= -�.- �. �-�s-r:=.� �..�.a�'-
D'P..REB't1R8R��� — - _ �-��`���,:��� _ � .f,�_=,�,� Y
Karen Harbison VP
�Preparer o(rhe Sala �isdosure Form Title
803 E State Rd 68 Elberfeld State Bank "
Addreu (Number and Street) Company
Elberfeld IN 47613
E-mail
:E=SELLER 8 ' GRANTOR S � _ �_ _ _ __ - -�- _ _-; - �_ :. ��u �`�.y���
Tammy Kelle
Seller ]- Name as appears on ronveyanre dorvment Se/ler 2- Name as appears an conveyanredacvment
7752 S 7 700 F
Addrus (Number and StrretJ Addrc[s (NUmber and Stree[J
Lvnnville IN 47619
Ciry, Smte, and ZIPCade Ciry, Smtg andZlPCOde
E-mail Tele haneNumber E-mail
Under penalties of perjury, I hereby certify that this Sales Disdosure, to the best of my knowledge and belief, is true, correct
and p[e as require b 1 w, and is repared in accordance wi[h IC 64.1-S.S, "Real Property Sales Disclosure Ac[".
�
�.� . 1'Yl'b(,� � l/ �' �/
� eo( ller � � Signamreaf5eller
Tammy Kelle �'� 12/09/2011
PnntedA'ameo/Selle� Si nDote MM/OD Pnn[edNameo Seller Si n0ale NMOD
: UYER 5 `.GRAi 6 �APP.ti[CATION?EOR+EROP.ERTYeTAX<DEDUC-TIONS�IDENTIFI'?ALL�ITEMS�THAT�APP.EY_4�"�`�.�g��i
Shelba J Lawrence
Buyerl-Nameasappea ronveyanredotvmen[ Buyer2�NOmeasappearsonronveyanredorvmml
78
Address (Number and Svee[) AdEres (Number and Street)
Princeton. IN 47670
Ciry, Sm[e, andZlPCade City. Sm[e, andZlPCode
$
Tele honeNum6er E-mail Tele hmeNumber E�mail
THE SALFS DISCLOSORE iOftM MdY BE USED TO APPLY FOR CEATAIY �EDULTIOtiS FOR TNIS PROPERTY. IDEY77FY ALL OF THOSE THAT APPLY.
YES \'O COYDITIO\ I COtiDIT ,
Q✓ � 1. Will this property be the buyer's primary ❑✓ ❑ 3. Homestead
residence? Provide complete address of prima , gy Heating/Cooling System
residence, including county:
1811 Taylor Ave ❑ ❑✓ 5. Wind Power Device
Addra�(NumberandSbeet) ❑ ❑✓ 6. Hydroelectric Power Devi�e
Princeton. IN 47670 Gibson � Q 7. Geothermal Energy Heatlng/Cooling Device
Ciry, Smte ZIP [ode Counry
� �✓ 2. Does the buyer have a homestead in Indiana to be � ❑� 8� �s this property a residen[ial rental proper[y?
vacated for this residence? If yes, provide ❑ ❑� 9. Would you like m receive tax statements for this
mmple[e address of residence being vacated, property via e-mail? (Provide contac[ information
including county: below. Please see instructions�or more in%rmation.
Nat available in all counties.)
Addres (A'vmber and StreetJ
�-/o?-�e -o?a3-oo�.�3 _ dad'
Ciry.SrureZ/PCOde Counry
Primaryproperryownerronruc[name E-mail
Under penal[ies of perjury, 1 hereby cerdfy that this Sales Disclosure, [o [he best of my knowledge and belief, is true, corred
and complete as required by law, and is prepared in accordance with IC 6-11-S.S, "Real Proper[y Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduc[ion is
bein f ed.)
�.e�-2� Q `'�.�c�,��,���—
� Signamre o/Bvyed SignoNre o(Bvya2/Spouse
PnnredLegalNameo(Buyert SignDate[MM/DD/YYYV� Pnn[¢dLNJalh'ameofBuyel2�5pause SignDa:e(NM/DD/IYY1�
�� ��%
LastSdigi[sojBuyer]Driver's Sm�e Las[SDigiesojSocial5ecvriryNumber Las[Sdigicso/Buye�2/SpouseDriver's Smte LastSDigiGSOfSociaiSecunty
LicensepD/OrherNumber Number 6icense/ID/OtherNumber