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= INDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
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;D:'-.PREPARER - �� :-ts��. �#.Yr,. -�:-��'�w��•�`�. �+ ��-`�- ..��, .�.-�.�-. -
' Karen Harbison VP
Neparero(the5ala Disdosure Fo�m Title
803 E State Rd 68 Elberfeld State Bank
Address(h'vmberand5'veetJ Company
Haubstadi IN 47639
E-mail
=E: SELL'ER S GRANTOR S ' ? , _ -^` . ` � - -_- - _,.� -�.�_ � ..�- � _ �� ;
D ni� . A�Taylor Jon T Tavlor
Seller 1- Name as appears on ronveyance docvment Selle� 2- Name as appears on cwveyanre document
?03 S Polk St 302 N Raca St
Address (Numbei and SvmtJ Address (Number and Stree[J
Fon Rren�h IN 4764A Haubstadt. IN 47639
Ciry.Sra[e, andZlPCode Ciry, Smte, andZlPCOde
E-mail
Under p^alties of perjury, 1 hereby cer[ify that [his Sales Disdosure, to the best of my knowledge and belief, is [rue, correct
and c� mple[e as required by �v, ay is prepared in accordance with IC 1.1-�.s, �eal�{'operty Sales Disclosure Act".
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SignamreofSeler / S' naNreo(Seller
�� J/ Jon T Tavlor 11-01-2012
PnnledNameo(Seller SionDuteMMDO PnntedNameaSeller SinDate(MMDO/YYY1'1
.. _ _ __ _ _• -__ __ - _ _� _ �`_. _
.EBUYER S GRANTEE S .�e1P,PL'ICATIONfF,OR'BROPERTY.;TAk-DEDUCT[ON5=-IDENTIFX%RIL�ITEFiSaTHr1T,APPIY'a =_
Jon T Tavlor Breana R Tavlor
Buve� 1- Name as appears on canveyonte daummt Buyer 2� Name as appears on ronveyanre dacvmen[
302 N Race St 302 N Race St
Addrus (Numbe� ond StreetJ Addrus (Num6er and Stree[J
Haubstadt.IN 47639 HaubstadtlN 47639
Ci.ry.Smre, and ZIPCode Ci.y, Sm[e, and ZIPCode
E-mail Tele honeNumbe� Email
THE SALES DISCLOSUR! FORM MAl' BE USED TO APPLV FOR LERTAIR DEDURIONS FOR THIS PROPERTY. IOEYTIF1' ALL OF THOSE THAT dPPLV.
YES NO CO\DITIOY I 1'FS NO CO\DITIOY
� ❑ 1.1h'ill this proper[y be the buyer's primary � ❑ 3. Homestead
residence? Provide complete address of primary � � 4. Solar Energy Heating/Cooling Sysrem
residence,includingcounty: � �
'im N Race St S. Wind Power Device
Addresr(A'umberond5vret) ❑ Q 6. Hydroelectric PoH�er Device
Haubstadt IN 47639 Gibson � Q 7, Geo[hermal Energy Heating/Cooling Device
Ciry, Sm:e ZIPCadr Cavn.y
❑ 1,7J 2. Does the buyer have a homestead in Indiana to be
❑ Q 8. !s this property a residen[ial rental property?
vacared for this residence? !f yes, provide ❑ Q 9.11'ould you like to receive tax s[atements for this
complete address of residence being vacated, property via e-mail? (Provide conmct in%rmation
including county: 6elow. P(ease see instructions for more in%rmation.
Not availa6le in all counties.)
Addresz (Num6e� and Street)
crq�. sca�e z�r cm� co��ry
��� /9 •3/ 30 / o00 ��tQ �
Pnmary pmperry owne� ronmct name E-mail
U��der penal[ies of perjwy, I hereby cer[ify tha[ [his Sales Disdosure, to the bes[ of my knowledge and belief, is true, correc[
and complete as required by law, and is prepared in accordance with IC 6-1.1-S.S, "Real Proper[y Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/0[her nu ers are no[ necessary if no Homestead Deduction is
being fil��
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� naNrea(BUyeA � S�gnamreofBuyer2/Spause
Inn T Ta�lor 11-01-2012 Braana R Ta�lnr 11-01-2012
PnnlPdLegalh'ameo(Buyel] SignOa[e(MH/DO/YYl'1�
SpauseDriver't Smte Las[SDigiGCOfSocialSecunty
Llrense/10/OrherA'umber Number License/ID/OrherNumber
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