Homestead_Heldt (16)IN�IANA SALES DISCLOSURE FORM1t SDF ID: Pa e 2
D.PREPARER �
,Val J. Fleiq Attornev at Law
Preparer o(Ne Safes D'udosvre Form Title
105 North Ninth Sireet
Addresx (A'umbe� and SneerJ Compvny
Petersburq IN 47567 (
E-mail
E. SELLER S GRANTOR 5
Vonda E Rosc Vonda E Heldt Revocable Living Trust
Selfer I- Name os appears m mnveyanae document Seller I� Name as appears on romeyante dxumenl
7325 S 500 W 7325 S 500 W
Address (Num6er and Street) Addrus (Number and Sveet)
Owensville IN 47665 Ow2nsville IN 47665
E-mail
Under penalties of perjury, t hereby certify that this Sales Disclosure, [o the bes[ of my knowledge and belief, is true, correct
and complete as required by I w, and is prepared in accordance with IC 6-11-5.5, "Real Property Sales Disdosure Ac[".
�� � ��.� �. �� .�� 4y�..�
5(qnomreof5eller �- S(qnaNreofSeller
Vnnda F Ross 1'I/06I20'i2 Vonda E Ross Trustee 11/06I2012
Pnn[edA'ameafSeller SiqnDateMM/DD Pnn[edNameoSelfer SionDo[efMM/OD
F. BUYER S GRANTEE S- APPLICATION�FOR PROPERTY TAX DEDUCTIONS- IDENTIFY ALL ITED4S THAT APPLY
Glen M. Heldt Paula M. Heldt
Buver 1- Nome as appears on ronveyana documen[ Buyer 2- Nome as appears on ronveyonce dommen[
732 S. Co. Rd. 175 E 732 S. Co. Rd. 775 E.
Add�ess (Num6er and Shee[J Addrus (Numbe� and SVeetJ
Winslow IN 47598 Winslow IN 47598
( �
Tele honet:umber Email Tele honeNumber E-mail
TNE SdLFS DISCLOSURE FORM MAY BE USHD TO APPLY FOR CERTAIY DHDUCfIOXS FOR TNIS PROPERTY. IDEYTIFY ALL OF THOSE THAT APPLY.
YES NO COSDITIO.�' � ( 1'FS \0 CO\'DITIaN
�✓ � 1. bVill this property be the buyer's primary Q ❑ 3. Homes[ead
residence? Provide complete address of primary � � 4. Solar Energy Heating/Cooling Syscem
residence, including county:
9244 S. 100 E. ❑ Q✓ S. Wind Power Device
Addrus(Numberand5treet) ❑ ❑✓ 6. Hydroelectric Power Device
Fort Branch IN 47648 Gibson � Q 7. Geothermal Energy Heating/Cooling Device
Ciry, Smre LP Code County
Q � 2. Does [he buyer have a homes[ead in Indiana to be � 0$� �s this property a residen[ial rental property?
vaca[ed for this residence? If yes, provide ❑ ❑✓ 9. lNould you like to receive tax statements for this
complete address of residence being vacated, property via e-mail? (Provide contatt in/'ormotion
including county: 6elow. Please see insfructions for more information.
732 S. Co. Rd. 175 E Not availa6le in all counties)
Addrus (Number and Svee[J M �![[
Winslow. IN 47598 Pike ,� /„ ��� � p� — �/ �043 � 7�Ja 5
Ciry.Sm[eZIPCode County �'9=Y /
Primary properry owner ronmR name E-mail
Under penalties of perjury, I hereby certify [hat this Sales Disclosure, to the bes[ of my knowledge and belief, is [rue, correc[
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Ac[". (No[e:
Spouse information, Social Security and Driver's License/Other numbers are no[ necessary if no Homestead Deduction is
be��d.) -� ` n
�-. C`� �.�� `FYQ �� `iYl `%�.e�c��.
Signamreo(BUyul S{qna[ureo(Buyer2/Spouse
l:lon An Holrlf 11I06I2012 Pa la M Hclri} 71/06/9012
Prin[edLegalA'ameo(Buyerl S{qnDate(MM/OD/YYY17 Prin[edLegalNameofBuyer2/Spouse SignDv[e(HH/00/YYY1')
/
LascSdigiao(BuyerlDriver's Smte LastSDigirsof5ocial5ecuriryNum6er LastSdigiuo(Buyer3/SpouseDriver'S Srnte LaslSDigitsojSoria/5ecuriry
Lirense/lD/OtherNum6er Num6er License/ID/OtherNumber