Homestead_Elpers (39)�
• INDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
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Karen R Harbison VP
Preparero(the5alaDisdasureForm Title
803 E State Rd 68 Elberfeld State Bank
Addras(Numberand5vee[)
Ciry, Sm[e, and Z/PCOde Telephone Nvmber Email
,E:SEL'I:ER S GRANTOR S �y � ,� :�x__� :r� �. -,'"i- �- ��,�_-- = � '�"� � . �:�-� � �i��,,.'ir
Lvnn ers Che���lners
Seller ]� Name as appears m mm�eyanre dotvment Seller 2- Name as appears om m�veyanre documen[
2352 E WarrPnton Rd 231 E 1200 S
Address(NumberandSVeet) Addrat(Numberand5tree[f
HanbctadtlN 47639 HaubstadtlN 47639
Under penaities of perjury, I hereby certify tha[ [his Sales Disclosure, to the bes[ of my knowledge and belief, is true, correct
and com [e as re uired by law, and is prepared in accordance wi[h IC 64.1-S.S, "Real Property Sales Disclosure Act".
� �.�'�1�,,,�� D 2_ �9��_,0
Signam� (Seller � SignaN�eofSeller
l vnn A Ipers 11I6/2012 Chervl A Eloers 11I6I2012
Pnnted,Vamea/Shcer SlonDa[e MM DO/YYYYi PnntedNameo Seller SiqnDa[efMM/DD
___ ._. _ _. _ _ _" . —_ _�. —_'_ _.z .
„F:';B � S' GRANTEE 5 � =�AP,PL'ICATIONiF,OR;BROP.ERTY�Tr1X+DEDUCTIONS :IDEN�TIF�YrAI.'L�IT.EFIS�THATnAPPL`Y,- _�,. "_�._�; ,:
L nn A EI ers
. - - mm�veymredorument Buverl-NameasapPearsonronveyanredrcumenc
231 E 7200 S
Address (NUmberand Svee[) Add�ss (Nvmber and Svee[J
Haubstadt IN 47639
Tele honeNumber E�mail Tde honeNumber £-mail
THE SALFS DISQOSORE FOR,N DIAY BE USED TO APPLI' FOR CEATAIN DEDURIORS FOR THIS PROPERTY. IDEhTIFY ALL OF THOSE THAT APPLY.
}'FS \O C05DITI01 I YDITI08
� ❑ 1. lVill this property be the buyer's primary � � ❑ 3. Homes[ea
residence? Provide complete address of primary � Q 4. Solar Energy Heating/Cooling System
residence, induding county:
�352 E Warremon Rd ❑ ❑✓ 5. Wind Po�ver Device
Addras(NUmberand5vtt[J ❑ Q 6. Hydroelectric Power Device
HaubstadtlN 47639 � Q 7.GeothennalEnergy Heatlng/Cooling Device
Ciry. Smte ZIPCade Cavnry
❑ � 2. Does the buyer have a homes[ead in Indiana to be � � $� �s this property a residential ren[al property?
vaca[ed for this residence? If yes, provide ❑ � 9. Would you like to receive tat statements For this
complete address of residence being vacated, property via e-mail? (Provide mntact informatlon
including count}e . ease see ms � ormation.
Not available in all rounties.)
Addras (Nvm6er and SueetJ
°IC�-�3-/�-4ov- oo/.oL�-o.�y
Ciry.Sm¢LP[ade Counry
Pdmaryproperryownerronmaname E-ma+�
Under penalties of perjury, I hereby cer[ify that [his Sales Disclosure, [o the bes[ of my know edge and belief, is true, correc[
and complete as required by law, and is prepared in accordance with IC 6Q.1-5.5, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
being filed.) /^''^
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Signamreo(Buy�er Signamreo(Buyrr2/Spaute
/
Lynn A ElnPrc 11/fi/2019
LastSdigitsofBuye�lDriver's 5[ote LastSDigiao�5ocia15ecurityNumber LastSdigiGSOjBuyer2/SpouseDriver's Smte dast50igi[tofSocialSecunty
Lirense/(D/OtherNumber Num6er License/ID/OlherNum6er
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