Homestead_BaneINDIANA SALES DISCLOSURE FORM SDF ID SDO ID 1394640 . � Page 2
D.PREPARER
Peggy A Ralston Title Assistant
Pi�epnrer of the Sales Disclosure Form Title
3101 N. Green River Road Suite 130 Trustworthy Land Title Co. Inc.
Address (Number and Street) ��
E. SELLER S GRANTOR S
Thomas L. Naas
Seller 1- Name as appears on conveyonce document Se!(er 2- Name us nppenrs on conveynnce docirment
819 E. 1200 S.
Address (Nuni6er antl Str�eet) Address (Nu�riber n�id StreetJ
Haubstadt, IN 47639-
Tele hntte Number E•mnil Tefe hone tiurnber G-mnil
Under pen 'es of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and comp e quired by law, d is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
,�Siguature o/Seller Si9naLUre of Seller
��, ��.�. S t� Nc�a.� �� aa-� a
,
F. B[IYER S GRANTEE S- APPLICATION FOR PROPERTY TAX DEDUCT[ONS- IDENTIFY ALL ITEMS THAT APPLY
Gregory K. Bane Stacey M. Bane
Bwer 1• Name as appears on conveynnre document Buyer Z- Nnnte as nppears on convevnt�ce docinnent
706 E. Haub Street 706 E. Haub Street
Address (Number and Street) Address (NumGer an�i Street)
Haubstadt, IN 47639- Haubstadt, IN 47639-
�
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTlONS FOR THIS P20PERTY. lDENTtFY ALL OF THOSE THAT APPLY.
YES NO COND1TlON YES NO CONDITION
XQ � 1. Will this property be the buyer's primary Qx ❑ 3. Homestead
residence? Provide complete address of primary � � 4. Solar Energy Heating/Cooling System
residence, inctuding county: �� 5. Wind Power Device
9902 MISTY LANE
Address(NumberandStreet) � � 6. Hydroelectric Power Device
Haubstadt, IN 47639 GIBSON � � �_ Geothermal Energy Heating/Cooling Device
Cery. State ZIP Code Coun ty
XQ � 2. Does the buyer have a homestead in Indiana to be
� Q 8. [s this property a residential rental property?
vacated for this residence? (f yes, provide ❑ Q 9. Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail? (Provide contact information
including county: below. Please see instructions for more information.
706 E. HAUB STREET Not available in all counties.)
Address (NumGer and Street)
Haubstadt, IN 47639 GIBSON � � �Q� `� � a�� (j� a � � � �,.� �
Ctty, State ZJP Code �' � us �^T
Cntm
Primarv p�•operty owner cnntor.t name F-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 Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
being filed.)
Sigr�atureofBuyer'] Signatur o 8 r' p ^
— �e.G�" /� t- �— o�.