Homestead_Russell (2)d
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
FD'RREPARER` ��-
Karen Harbison VP
Preparerof the Sales Disclosure Form Title
803 E State Rd 68 The Elberfeld State Bank
Address(Numberandstw) Company
Haubstadt IN 47639
E -mail
LE SEI L`ER S )`.GRANTOR S
Laura A Decker
'
Seller I -Name as appears on conveyance locomen!
514 W State Rd 68
Seller 2. Name as appears on conveyance document
Address (Number and Street)
Haubstadt IN 47639
Address (Number and Street)
City State, and ZIP Code
City, Stote, and ZIP Code
Email
I Telephone Number E -mail
Under penalties of perjury, 1 hereby certi that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and cam etc as require by law, and's t are in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ".
Signature of Seller Signatumcf5eller
z
Laura A Decker 0911512011
Printed Namem Seller 7 Sk Date NM 00 Printed No Seller Sian Date MM /DD
?F._�BUYER(S)7.G RANTE E (S ;" AP, P, L ICATI ONrEOR' P, ROP, ERIWJ AXiDEDUCT IONSVDENTIF,YrA1116ITEMS -ITHAT P. P,DY
Laura A Russell
Buyer] Nomeas appears on conveyance document
Buyer 2- Name as appears on conveyance document
514 W State Rd 68
Address (Number and Street)
Address (Numberand5veet)
Haubstadt. IN 47639
City, State, and ZIP Code
City, State, and ZIP Code
E-mail
Telephone Number 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 I YES NO CONDITION
❑ F71 1. Will this property be the buyer's primary
❑❑ 3. Homestead
residence? Provide complete address of primary
❑ ❑ 4. Solar Energy Heating /Cooling System
residence, including county:
❑ ❑✓ S. Wind Power Device
514 W State Rd 68
❑ 0 6. Hydroelectric Power Device
Address(NumberandScreet)
Haubstadt IN 47639
❑ 0 7. Geothermal Energy Heating /Cooling Device
❑ ❑� 8. Is this property a residential rental property?
City, State ZIP Cade County
❑ 0 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
❑ 2) 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)
Ciry. State ZIPCode County
Primary Property owner contact 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 by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ". (Note:
Spouse information, Social S urity and Driver's License /Other numbers are not necessary if no Homestead Deduction is
being!- Ili l�ejt'.} ( �7
SI — afBuyer7 �1 Signature ofBuyer2/spouse
Sign Once Printed Legal Name of Buyer 2 1Spouse sign Date(MM/DDIffm
Number Last 5 digits cfBuyer2 1Spouse Driver's State Last 5 Digits of Social Security
License /ID10ther Number Number License /ID 10ther Number