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Homestead_Lemeron , 2 I 3 1 t-} INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D.PREPARER ....t17. _t T..- ti.. -_ .. _ , -: . +_ .r.. .._ 'i , :..°:: .,. .`. 1 j c>. Karen Harbison VP Preparer of the Sales Disclosure Form ® Title 803 E State Rd 68 Title State Bank Address(Number and Street) Company Haubstadt, IN 47639 812-768-5800 kharbison(ahesbanc.com City,State,and ZIP Code - Telephone Number E-mail E.SELLERS)/GRANTOR(S) - '-' Dennis W Titzer _ -- Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 5900 S 1025 E Address(Number and Street) Address(Number and Street) Oakland City IN 47660 Telephone Number E-mail Under penalties of perjury, I hereby certify t r :t this Sales Disclosure,to the best of my knowledge and belief,is true,correct an plete as require. r .'l-:\v,and i : epared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". nature of Seller \ Signature of Seller Dennis W Titzer 02/12(2013 Printed Name of Seller Sian Date(•M/OD/YYYY) Printed Name of Seller Sian Date fMM/VD/YYYY) 'F.BUYERW/GRANTEE( -APPLICATION;FOR(PROPERTIYc TAX DEDUCTIONS:IDENTIFY;AELtITEMS,,THATYAP9LY-WS 1,,Z, i ri Shawn K Lemero� Buye.t N,,,,,eot nconveyance document Buyer2-Name as appears an conveyance document 10286E 600 South Address(Number and Sweet) Address(Number and Sweet) Oakland City IN 47660 - -- Telephone Number E-mail THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION RU�.ONBIiiO _ 0 ❑ 1.Will this property be the buyer's primary ���lll ❑ 3.Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: ❑ 10286E 600 South 5.Wind Power Device Address(Number and Street) ❑ 0 6.Hydroelectric Power Device oakland City IN 47660 ❑ 0 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ 0 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 in all counties.) Address(Number and Street) ado — 4)•0 // - a. 0 °- 1004 • /aa-001 City,State ZIP Code County 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 inform cial Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is being filed.) Signal re of B Signature of Buyer2/Spa use gli 'haws K I emernn 02/12(2013 Number License/ID/Other Number