Homestead_MabreyINDIANA�SALES DISCLOSURE FORM SDF ID: Pa e Z
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•C.PREPARER_. .. .- . f." <'_ ��-_ �'�,.�'a��-�`�`:�`� �:' :� ,3 �_:.,xt`-::
Karen Harbison VP
Neparero/Ihe Sala DisNOSUre Form Title
803 E Siate Rd 68 Elberfeld State Bank
Address (Num6er and SVee[) Compony
HaubstadL W 47639
E�mail
E.SELIER 5 GRANTOR S y � ���- ' - `�,?, , �-�;' -
CoreyJ Foster � M Foster
Seller 1� Name as appears on cwveyance docvmen: Seller 2- Name ot appears on convryance document
'�O 7 F� S��f� � N 403 F Sirain St
.tddrecs(Numberand5vee[J � ^ I Address(NumberandStree[)
�f'. ��[_,fln+C � �' �/ Ft Rranr.h IN 47648
City. S[ate, and ZIPCode Ciry, Sm:e, and ZIPCode
�!
E-mail
Under penal[ies of perjury, 1 hereby certify [ha[ this Sales-Disclosure, [o [he best of my knowledge and belief, is true, correct
and co���s�quir by I� , and is prepared in accordance with IC 6-1.1-S.�eal Property Sales Disclosure Act".
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G./ � /'�L o
� nal':e f5eller Si . a � e f�
Corv J Foster by,�3y M Foster POA 72/31/2012 ,l3y M osier 12/3U2012
PnntedNameo(Seller Si nDare MM DD Pnn[edName Si n0ale[MM/00
�ER S � G � TEE 5 .=AP.PCICATIOY'rFOR�PROEER-TYTAX DEDU - S�IDENTIFYlAL'I�ITEMS'; � �� APPLY'l': �_�-_? -��
Patrick A Carlisle Brent J Mabre and Pam I J Mabre
Buyvl�Na ° - ppmrsomm�vryanredotvmen[ I uyer2-Nameosappearsonronveyanred .[
984 E State Rd 64
Ad r dSVee[) Address(Numberond5veer)
Francisco IN 57649 Fort Branch. IN 47648
Ciry, Smtq andZlPCode Ciry. SmtG andZlPCode
Email Tele honeNumbe� Emvil
THESALFSDISCLOSUREFORMAtdYBHUSEDTOAPPLVFORCFRTAINDEDUCf10N5FORTHiSPROP . SETHATdPPLY.
1'FS SO CO\DITIOA YFS NO COSDITIO\
I71 ❑ 1. \Nill this property be the buyer's primary I 0 ❑ 3. Home
residence? Provide complete address of prim 4. Solar Energy Heating/Cooling System
residence, including county: �
106 E UI .n St 5. Wind Power Device
Add�as(NumberandStreeQ ❑ � 6. Hydroelectric Power Device
R Branch. IN 47648 � Q 7. Geothermal Energy Heating/Cooling Device
Ci.y.Srn[eZIPCade CounN
❑ � 2. Does the buyer have a homes[ead in Indiana to be � 0 $• Is this property a residentlal rental property?
vacated for this residence? lf yes, provide ❑ � 9. Would you like to receive tae statements for this
complele address of residence being vacated, proper[y via e-mail? (Provide contact informo[ion
including county: below. Please see instruc[ions for more information.
Not available i Il counties.)
Addresf (h'umber and Svre[) � �
o1�-�d�/,�- �"/��- ODU.�o� 0
[iry.SmteZlPCode Counry -�
Pn'mary property ownerconma name E-mail
Under penalties of perjury, l hereby certify that this Sales Disclosure, to the bes[ of my knowledge and belief, is true, wrrect
and complete as required by law, and is prepared in accordance with IC 6-1.1•S.S, "Real Property Sales Disclosure Act". (No[e:
Spouse informa[ion, Social Seturity and Driver's License/O[her numbers are not necessary if no Homes[ead Deduction is
being filed.) •
��� ly ���. ' h� `�',
SigmNreofBvyvll �gnaNreof 2/Spouse
Patrirk A Carlida 17/31/7017 Brrnt I Mahrry / PamPla J Ma�yy 17I31I9011
PnntedLegalNameo/Buyu] SignDa:e[MM/DDp'YYI'� PnnredLegalNameafBuyer2/Spouse SignDate(MH/�D/YYYh
IN ( IN
Lns[Sdigi6ofBuyerlDriver's S[ate LaslSDigiuo�SatialSecvnryNum6er Las[SdigiGSO�Buyer2/SpouseDriver's Smte LastSDigitro(Socia(Security
Lirense/ID/OtherA'umber A'um6er Litense/ID/OtherNumber