HomeMy WebLinkAboutHomestead_Blankenberger (5)INDIANA SALES DISCLOSURE FORM SDF ID: Zp�2 pa,,,, �
D.:PREPARER
Sherri S hudson ClosinQ Aeent
Preparerof the Safes Disdosure Fonn Title
605 SE Martin Luther King Jr Boulevard Southwestem Indiana Land Title
Address (Num6erand Street)
E-mail
E. SELLER(S) / GRANTOR(S)
Kelly P. Haley Lori Haley
Seller 1- Name as appears on conveyance tlocument Seller 2- Name as appears on conveyance document
10197 S 350 E 10197 S 350 E
Address (NUm6er and Sfreet) Address (Num6er and Streef)
Haubstadt, IN 47639 Haubstadt, IN 47639
,
Under penalties of perjury, I hereby ceRify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and cort/�plete as reqJu ced by law, and is prepared in accordance with I 6- .1 •5.5, "Real Property Sales Disclo re ct".
—��1 6����i�l�l � �D l
Srg�aturea�S°eller 'Signature f eller
Kelty P. Haley �/ �p— f� Lori Haley
Printed Name of Seller Sign Date (MM/DDNYYY) Pnnted Name of Seller Sign Date (MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL ITEMS THAT APPLY
Jace A. Blankenberger
Buyer 7- Name as appears on conveyance tlocument Buye� 2- Name as appears on conveyance document
2448 W. 1000 South
Add�ess (NUmber and Streeq Address (Number and Streef)
Haubstadt, IN 47639
Telephone Number E+nail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR 7HIS PROPER7Y. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
❑ 1. Will this property be the buyers primary ,�1 ❑ 3. Homestead
residence? Provide complete address of primary p d 4. Solar Energy Heating/Cooling System
residence, including county:
❑ Ld' 5. Wind Power Device
10797 S 350 E
Address (Number and Street) ❑ I� 6. HydroeleCtfiC Power Device
Haubsfadt, IN 47639 ( Gibson � �� Geothermal Energy Heating/Cooling Device
Gry, Stare/ ziP Code County ❑ Q� 8. Is this propeRy a resideniial rental property?
� 0 2. Does the buyer have a homestead in Indiana to be � � g Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete property via-email? (Provide contact information
address of residence being vacated, including county: 6elow. Please see instructions formore information.
Not available in all counties.)
Address (Number and Streef/
��-i � 3�/ '�/06 Q6c'`/ l a a a v
Ciry, State ZIP Code County P�mary property ownercontact name � E-mail
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 AcY'. (Note: Spouse
inf rtnation, Social curi and Driver's License/Other numbers are not necessary if no Homestead Deduction is being filed.)
Signature of Buye 7, � -d /� Signature of Bvyer 2/Spouse
' '/
Jace A. Blankenber er � O-
Pnnt Legal Name of Buyer 2/Spouse Sign Oate (MM/DONYriJ
_;.
ast 5 digits o Buyer 7 Onvers Sfate Lasf 5 D'qits of Social Sewnry Number Last 5 digits ol Buyei 2 Drivers State Last 5 Digi,s o( Social Secunry Number
License/ID/Other Number LicenseJlD/Ofher Number