Homestead_Roberts INDIANA SALES DISCLOSURE FORM SDF ID: 2013 Page 2
D. PREPARER
Kathy Masterson Escrow Officer
Preparer of the Sales Disclosure Form Title
"05 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
ddress(Number and Street) Company
vansville, Indiana 47713 (812)425-0055 kathy@swinland.com
E-mail
City, State.and ZIP Code Telephone Number
E SEL•L'ER(S`I'GRANTOR(S)
Charles Michael Durbin Varoncia Lynn Durbin
Seller I -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
10415 S Pheasant Run 10415 S Pheasant Run
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
and co vpl�etttee as required law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
ure o/-Se ter, r )4•.j r1.�ture of_ eller ( 't'L!'L la[..l'.-✓lw-
L9 GSignature of Seller`
Charles Michael Durbin Varoncia Lynn Durbin
Prin'a • .. _ -' -her SigmDate;(MM/DDY,Y,YYY) Printed Name of Seller ESign:Date'(MM/DD/Y ZY)_ .
•_BUYER(S)/BRAN •E(S)2APPL_ICATION FOR PROPERTY TA % I UCTIONS - IDENTI ' • L ITEMS THAT APPLY
•
Mark D. Roberts Nichole D. Roberts
Buyer I-Name a .spears on conveyance document ----au er 2- -..- - -- --rs on conveyance document
10 • . Fifth Ave. 103 N. Fifth Ave.
4ddress(Number and Street)
�
Address(Number and Street)
ubstadt, IN 47639 Haubstadt, IN 47639
•
/
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAI UCTIONS FOR THIS PROPERTY. DENT! LL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
- ❑ WWII this property be the buyer's primary 17 ❑ 3. Homestead
residence? Provide complete address of pri ❑ 2 4. Solar Ene trig/Cooling System
residence,including county:
❑ -PY-5—Ind Power Device
10415 S Pheasant Run
Address(Number and Street) ❑ 2 6. Hydroelectric Power Device
,Haubstadt, IN 47639 Gibson ❑ 2 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ ❑ 8. Is this property a residential rental property?
❑ �( 2! Does the buyer have a homestead in Indiana to be ❑ 0 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete property via-email? (Provide contact information
address of residence being vacated, including county: below. Please see instructions for more information.
Not available in all counties.)
Address(Number and Street) w� /A56- -£ 2d. 4 C/,//-� 6 J //
City, State ZIP Code County Primary property owner contact name E-mail
Under pen. ties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and
complet/s required by law,and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". (Note: Spouse
infform J-o c'"-I Security and Driver's License/Other numbers are not c ssary if no om tead ction is being filed.)
/ f /--� ofBuye�� �
, - ature oL yer_IJg afu of BuyecP/Spouse -- /� /�
tr,'..rk D. Roberts 3 _ Nichole D. Roberts �—/