Homestead_Blankenberger (2) '
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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2'
VOTRREP;ARER< ' :.-. -,.€.t ' --r--- - 7—.7-77•77-..7.----c,• 79'-._; i - - -.----
Karen R 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 812-768-5800 - kharbison @esbanc.com
City.State.and ZIP Code Telephone Number E-mail
;Ei;S Th-R(S alk—NTOR(S)b ' - . . --. .. -- --- —" • : . -TIT— -7-77:77-;.
Bandon L Conner
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
5046E 825 S _ _-__-_ .
Address(Number and Street) Address(Number and Street)
Ft Branch In 47648
Telephone Number E-mail
Under penalties of perjury,I he eby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and rt plete as red 4y45w,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
/Siiggnaatture of Seller Signature of Seller
Brandon L Conner 03(15(2013
Prjas.estilasiZeller.v Sian Date NH/DO/MI) Printed Name of Seller Sian Date(MM/DO/YYYf
LE0,1)YER(S)%G NTEE( h�ABBM GATION;FORIAROPERTYCFAXWERUCT10NSt.IDENTI$Y_'A RITIStTHAT,AP;ellYr -1
< Brian M Blankenbye
'T� ewrs on conveyance document Buyer 2-Name as appears on conveyance document
2• • -.!
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639
Tele hone Email
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FO PR TY. IDENTIFY ALL O SE THAT APPLY.
1' NO CONDITION YES NO CONDITION
( 1.Will this property be the buyer's primary ❑ ❑ 3.Homestead
(\ Y3 residence? Provide complete address of Kimary U IYI 4.Solar bnergy Heating/Cooling System
residence,including county: ❑ ❑
5046E 825 S 5.Wind Power Device
Address(Number and Street) ❑ I7j 6.Hydroelectric Power Device
Ft Branch. IN 47648 ❑ 0 7.Geothermal Energy Heating/Cooling Device
City;State ZIP Cade County
❑ Q 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 ❑ 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 i I counties.) /
Address(Number and Street) ( ( -/9� .// a-5��• .30//��5-
City,State ZIP Code County ��,777 //Ifs 7
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 Homestead Deduction is
b•ing filed.)
! vt..:�.... _
Signature of Buyers - Signature of Buyer2/Spouse
Brian M Blankenberger 01152019
Number License/ID/Other Number