HomeMy WebLinkAboutHomestead_Harris (3)� INDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
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�D=P.REPARER- . .�__ �. _.;.:-. :".: � x,..;�����..���-°�,,��-,:.�" _ _,������,-��-�,..��
Karen Harbison VP
R'eparerof rhe Sala DBdosure Form Title
803 E Siate Rd 68 Elberfeld State Bank
Address(NUmberand5vee[J Company
Haubstadi IN 47639
E-mail
E.SEI:I;ER 5' GRANTOR S _ `�v^z= s��` ��-��:_ =i�'r-' : _ ����'y, �i. '_-�"7::r�� --�._-��_ �''�:6_�.r-:�
Dan P Harnc .ludith P Harns
Selle� I- Name ar apyears on ronveyanre dotument Seller 2� Name as appears on ronveyante da'umen[
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Addrgs(Numberond5treet) Addras(Numberand5tree[)
Hanbaadt W c7639 HaubstadtlN 47639
Ciry, Smtq and ZIPCaGe Ciry.Sta[q and Z/PCode
E-mail
Under enalties of perjury, 1 hereby cer[ify that this Sales Disclosure, [o the bes[ of my knowledge and belief, is true, correct
and om e[e as required by 1 v, and 's epared in accordance � i[ ' IC 64.1-S.SrJ�a Proper[y Sales Disclosure Act".
Vi
' Signamreo(Sello Si aN�ea(Seller
Danny P Harris 12/14/2012
PnnledNa SionDare(MN/00 PnntedNomeofShcer SipnDa[GMN/DD
� XER S ,GRANTEE 5 _ P,PI7ICATION:EOR�PROPERTY3Tr1X!DE - �AIiL'iITEh1S;THe1T�APPL`Yz —,�,�'�.:��
Jeremiah E Harris Kell L Harris
Buyerl�A'ameasappea onvryanredorument Buyu2�Nameasappevrson vryoncedavmm[
I SOfI $i
Addrus(Numberand5[reet) Address(Numberand5veetJ
HaubstadtlN 47639 HaubstadtlN 47639
f-mail
THESdLFSDISCLOSUREFORPiMdYeEUSEDTOAPPLI'FORCERTdi\DHDURIO\SFORTHISPBOPERTY.IDE�TIFS'ALLOFTHOSE PPLS.
1'FS %0 CO\DITIOY � 1'FS NO CO&OITIOY
I� ❑ L Will this property be the buyer's primary � ❑ 3. Homesread
residence? Provide complete address of'pri � 0 4. Solar Ener ' o Cooling System
residence, induding county: � �
Sn5 F C;ibson St 5.4Vind Power Device
Add�ut(Nvmberon05[�eet) ❑ � 6.HydroelectricPowerDevice
Haubstadt IN 47639 � 0 7. Geothermal Energy Heating/Cooling Device
Ciry.SmreZIPCOde lounry
❑ � 2. Does the buyer have a homestead in Indiana Io be � � $� �s [his property a residentlal rental property?
vacated for this residence? If yes, provide ❑ 0 9. Would you like [o receive taY statements for this
mmplete address of residence being vacated, property via e-mail? (Provide contact information
including county: below. Please see instructions for more in%rmation.
Not available in all munties.)
Addres (Num6e� and Svretf j /�y� �/��
Ciry.SmaZIVCode Counry �—/�_`�/_��\� `
Pdmary properry owner conmct name E-mail
Under penalties of perjury, 1 hereby certify tha[ Ihis Sales Disclosure, to [he best of my knowledge and belief, is [rue, [orrec[
and complete as required by law, and is prepared in accordance with IC 6-1.1-S.S, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
bei filed.l � � / �M �� /�j
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5' amreofBvyer] Signamreo(Buyrr2 p se
Krl�y l Harric 1 2114/20 7 2
PnnredLegalNameofBvyer] SignDate(MM/DU/YI'Y17 PnntedLegvlNameafBuyer2/Spouse SignDatt(NN/DD/IM1'YI]
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Social5ecunry
License/ID/OtherNum6er Num6er License/ID/OtherNumber
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