Homestead_Burton (3)INDIANA SALES DISCLOSURE FORM SDF ID:
D.PREPARER
Preparer oj the Soles Disrlosvre Form
PO Box 13. 219 N. Hart Sl.
�ddres(Numberord 5[ree[)
ceton IN 47670
liry; Stute, and ZIP Cade
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Seller 1-,Yame os oppeorsan conveyance daaument
504 S. 9th Avenue
Addres (Number and Stree[)
Haubstadt IN 47639
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Hall, Partenheimer 8 Kinkle
Campony
E-moil
Seller 2- Nome os appears on canvnnnce domment
Addre.a /Number ond Stree[J
City, Smte, anJ ZIP Code
F-mufl
Under penalties of perjury, 1 hereby cer[ify that [his Sales Disdosure, to the best of my knowledge and belief, is true, correc[
and complete as required b law, and is prepared in accordance with IC 6-1.1-S.S, "Real Property Sales Disclosure Ac[".
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Addres (Number und SveetJ
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TAX DEDUCTIONS- IDENTIFY ALL ITEMS THAT APPL1'
Buyrr 2� Nan�e us oypmrs om m�vqm�nce Ja[vmmf
AJJress (Nurnber and Slree[)
Ciry, Smtu, onJZIPCodr
THE SALFS DISCLOSURE FOMI MAY BE USED T0.IPPLY FOR CERTAIN DEDUCfI0N5 FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
NO CONDITION
Q � 1. Will this property be the buyer's primary
residence? Provide complete address of E
residence, including county:
Addrrs (Number ond Street)
Haubstadt.IN 47639 Gibson
Liry.Smte ZIPCode CounN
0 ❑ 2. Does [he buyer have a homestead in Indiana to be
vacated for this residence? IFyes, provide
complete address of residence being vacated,
including counry:
870 W. River Road
Addre.s /A'umber ond Stree[J
Petersburq IN 47567 Pike
Ciry, Smte ZIP fude Counp•
0 ❑ 3. Homes[ead
System
❑ ❑✓ 5. Wind Power Device
❑ Q 6. Hydroelectric Power Device
❑ � 7. Geothermal Energy Heating/Cooling Device
❑ ❑✓ 8. Is this property a residen[ial rental property?
❑ � 9. Would you like to receive tax statements for this
property via e-mail? (Provide contact injormation
below. Please see instructions jor more information.
Not available in al! counties.J
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Janice Carol urton
E-moil
Under penal[ies of perjury, l hereby certify [hat this Sales Disdosure, [o 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-S.S, "Real Property Sales Disdosure Act". (Note:
Spouse informadon, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deducbon is
b ' gfiled.)
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o(Social5eruriry Number 6ost 5 digiGS o�Buyer 2/Spouse Drive�'s Smte Lost 5 Digiu o�5ocial Securiry
License/fD/OtherNumber Num6er License/lD/O[herNum6er