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INDIANA SALES DISCLOSURE FORM SDF ID: � Pa e 2
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Karen R Harbison VP
Preparer of the Sala Disdasure Form TiUe
803 E State Rd 6S - Elberfeld State Bank
Addreu(NUm6erandStree[J Compony
HaubstadllN 47639
Ciry, Sm[e, md ZIPCode Telephone Number E-mail
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�E?SE[;I:ERB'.GRANTOR S �;�'�,�;,--�'��f ����.'�:,'�,�-�''� �` --�-'��.� ��
Brandon J Pegram Heather D Tichenor
Shcer t- Name as appears om m�veyonce dxummt Selle� 2- Name as appmrs om m�veyonre dxvmmt
6903 S 600 W 6903 S 600 W
Addres(NvmberandStree[) Address(Numbermd5beet)
(hvansvillP. IN 47665 (hvensville IN 47665
Ciry,Sm[qandl/PCade �['` ',
f-mail Te/e honeNUmber &mail
Under penal[ies of perjury, I hereby certify [hat [his Sales Disclosure, to [he best of my knowledge and belief, is [rue, correct
and comp ete as required by aw, and is prepared in accordance with I� 6-1.1-5.5, "Real Pr rt�Salr�Disc��l/! �
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�SignaN of5eller �ignaNreoJSeller
Brendon J Pe9ram 10I04Y2012 Heather D Tichenor 10I04I2072
the buyer's primary Q ❑ 3. Homestead
residence? Provide comple[e address of primary � � 4. Solar Energy Heating/Cooling System
residence, including county: � �
6903 S 600 W 5. Wind Po�ver Device
Addreu(Nvmberand5vmt) ❑ � 6. Hydroelec[ric Power Device
Owensville. IN 47665 Gibson � � 7, Geothermal Energy Hearing/Cooling Device
[iry, Smtt Z/PCOde Counry
� � 2. Does [he buyer have a homestead in Indiana to be � 0 $• �s this property a residentlal rental property?
vacated for this residence? If yes, provide ❑ � 9. Would you like to receive tax statements for [his
complete address of residence being vaca[ed, property via e-mail? (Provide contoct information
including county: below. Please see instructions far more information.
Not availa6/e in all rounties.)
.Iddreu (NUm6er and Svee[)
ab - ��-� �• �o� a� � 7�s9 o�J
Ciry, Sma LP [ade Counry
Mmarypmpotyawnerronmc[nume E-mail
Under penal[ies of perjury, I hereby certify tha[ [his Sales Disclosure, to the bes[ of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance wi[h IC 6-11-S.S, "Real Property Sales Disclosure At[". (No[e:
Spouse informa[ion, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deducdon is
being filed.) VI�/��i7 J ��, ,^ �� ������
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Signam� o/BuyeN SignaNreo(Bvyer2/Spause �
Heather D Pa9ram 10/0412012
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