HomeMy WebLinkAboutHomestead_ConreyINDIANA SALES DISCLOSURE FORM SDF ID: Pa Re 2
gD�P.REPARER
Karen Harbison VP
Preparer of the Sales Disclosure Form Title
803 E State Rd 68 Elberfeld State Bank
Address (Number and Street) Company
Haubstadt IN 47639
Email
E.SELLER S',GRANTOR S g- � fl =
Monica A EDnPrson
Seller I - Name as appears an mnveynnce document Seller 2 - Name as appears on conveyance document
803 West Gibson St
Address (Number and Street) Address (Number and Street)
Hal hctadt IN 47630
City, State, and ZIP Cade City; State, and ZIP Code
Email I Telephone Number E -mail
Under penalties of perjury,) hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as required' law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ".
7)202 c,[,�. �i. , �t'h��✓y
SignaNre of5eller Signature ofSellor
Monica A Fripercnn 19109190 11
Printed Numeo Seller Sian Date MM/DD/YYYi'I Printed Nameo Seller Sign Dam MN1DD1YYn'1
F: NTEE S I e APPL-- IGATION1EOR!PROPERTYTAVDED VZ1 -I A,1301TEMS'THATrAPPLY:V -. -
Casey L Conre —Amanda S Naas
Buyer I - Name asa rs an conveyance document Buyer2 Name rsommnvayaacedocumenl
1025 S 918 W 1000 S
Address (Number and Street) Address (Number and Street)
Haubstadt IN 47639 Haubstadt IN 47639
Email
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION
./❑ ❑ 1. Will this property be the buyer's primary ❑✓ ❑ 3. Homestead
residence? Provide complete address of primary eating /Cooling System
residence, including county:
710 N Campbell BNd ❑✓ S. Wind Power Device
Address (Number and Street) ❑ ❑� 6. Hydroelectric Power Device
Haubstadt IN 47639 Gibson ❑ 0 7, Geothermal Energy Heating /Cooling Device
Ciry,Slate ZIPCode County
❑ ❑J 2. Does the buyer have a homestead in Indiana to be ❑ ❑� 8. Is this property a residential rental property?
vacated for this residence? If yes, provide ❑ 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.
Not available in all counties.)
Address (Number and Street)
-J 171411 CCo 1. 24 -Q9
Ciry, State Z1PCode County
Primary property mvnercomact name E -mail
Under penalties of perjury, 1 hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as required bylaw, and is prepared in accordance wit 6- 1.1 -5.5, "Real Property Sal Disclosure Ac[ ". (Note:
Spots information, Social Security and Driver's License /Other n rb s are no[ cessary if no Ho es[ ad Deduction is
n ed. 1
.0 .err g7atureofBuyer21Spouse
1 Q10912011 Amanda C Naac 121092011
Panted Legal NameofBuyer l Sign Dow(MM/DD/YYY1)
License /ID /Other Number Number License /ID /Other Number