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INDIANA SALES DISCLOSURE FORD7 SDF ID: Pa e 2
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Karen Harbison VP
Preparero(Ne Safes Dudasure Form Title
803 E State Rd 68 Elberfeld State Bank
Address (Num6er and Street) Company
Haubstadt IN 47639
Ciry, Sm[Q and Z1PCade Telephone Nvmber Email
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Dakota � Ri k r � orv B WibbarhPr
Sellerl-Nameasappevrsonronveyanaedocument � Seller2�Nomearappearsoncomn•anredxument
67"tfi W 400 S 6716 W 400 S
Address (NUmber and Street) Address (Number and 5[rre[)
OwPncville IN 47fi65 Owencville IN 476fi5
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E-mail TNe honeNumber E-ma(1
Unde enal[ies of perjary, 1 hereby cer[ify tha[ [his Sales Disclosure, [o the best of my knowledge and belief, is true, wrrec[
a co I[e as req ' by law, and is prepared in accordance wi[h IC�-5.5, "Real Pr pe ty Sales Disclosure AcC.
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F=6UYER S' GRt1N E S?-AP.P,I:IQATION?FOR�PROPERTP;T' ' GTIONS`y� . IFY;AL'LiITENiSkTHe1T=APP,LY�=��' �'�%;-:
Dakota J Ricker Lo B Ricker
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6736 W 400 S 67 S
,lddress (Nvmber and SveeQ Addr¢s (NUmber and Street)
Owensville IN 47665 Owensville IN 47665
Ciry, Smle, and ZIPCOde
E�mail Te/e honeNum6er E-mail
THESd1,FSDi5CLO5URHFOR,Nh1AYBEU5EDT0APPLVFORCERTAIBDEDURI0N5FORTHI5Pft0 . TNOSETHATdPPL1'.
YFS NO COSDiT109 � 1'FS NO CONOITIOY
A� ❑ 1. 4Vi11 this property be [he biryer's primary f-�✓ ❑ 3. Homestead
residence? Provide complete address of pr a i , nergy Heating/Cooling Sys[em
residence, includin; county: I
fi736 W 400 S I � S. Wind Power Device
Addreu(Numberand5trret) ❑ - 6. Hydroelectric Power Device
Owensville IN 47665 Gibson � � 7, Geothermal Energy Heaung/Cooling Device
Ciry, Smce ZIPCade Counry
❑ � Z. Does [he buyer have a homestead in Indiana to be � 0 $• �s [his property a residential rental property?
vacated (or this residence? If yes, provide ❑ 0 9. Would you like to receive ta�c sta[ements for this
complete address of residence being vacated, property via e-mail? (Provide ronmct information
induding county: 6elow. P(ease see instructions for more in%rmadon.
Not available in aIl counties.)
Addras (Numbe� and Svre[)
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[iry.5m[eZIPCade Caunry —
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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". (Note:
Spouse' formajion, Social Security and Driver's License/O[her numbers are not necessary if no Homestead Deductlon is
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