HomeMy WebLinkAboutHomestead_Rexing (18) • INDIANA SALES DISCLOSURE FORM SDF ID: I ' I. 5 Page 2
I) PREPARER.' - . S._ "lY i l aL. 7-'-' s _. ,AV:raM 1
Karen Harbison VP
Preparer of the Sales Disclosure Form Title
803 E State Rd 68 Haubstadt State Bank
Address(Number and Street) Company
Haubstadt IN 47639 8127685800 kharbison @esbanc.com
City,State,and ZIP Code Telephone Number E-mail
E.SELLER GRANTORS) _f : — L_ .a ;x;<':i ri-_'1. ,
Jack N Field and Aaron J Field Adam C Adler
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
273 W 1200 5 12202 S 50 W -
Address(Number and Street) Address(Number and Street)
_Haubstadt IN 47639 Haubstadt IN 47639
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
ij complete required law,and is pr pared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
ja r ,. ! • —=kll
i ' Q.,/�' 3,6A0/3
gnature ofSeller J• Signature of Seller
Jack N Field and Aaron J Field 3/06/2013 Adam C Adler 03/06/2013
Printed Name ofSeller Sian Date(MM/DU/YYY1'I Printed Name of Seller Sian Date(MM/DO/rm'(
=-F:13 - ,- r-; • - ,EE(S)' .APPEICATION WP,,ROP,ERTytTAX4DEDDU- 7,) II I!! r, :4 L°L°)ITEMS;THAT°APRifira ' -- -'!
- Lee D Rexin• Chelsea N Wars-I
4 Buyer! Name as a• .rs on conveyance document `— Buyer 2-Name as ap.... . c o n v e y a n c e document
F• 50 E 30 Mill Rd
•dress(Number and Street) Address(Number and Street)
Haubstadt. IN 47639 Evansville, IN 47720
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling System
residence,including county: ❑ or
269 W 1200 S S.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Haubstadt. IN 47639 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device
Ciry,State ZIP Code County
❑ 0 2.Does the buyer have a homestead in Indiana to be ❑ 0 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 0 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) (/��
City,State ZIP Code County or I12 -il i�' 0D�• 7'O�
Primary property owner contact name E-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 H mestead Deduction is
being filed.) I, l °DA a Signaave ofBuyeerr J Signature of Buyer2/Spouse
lee D Rexing 03/06/2013 S)hnlsea N Wargel 03/062013