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HomeMy WebLinkAboutHomestead_Kell INDIANA SALES DISCLOSURE FORM MW ID SDO ID 1769754 _ Page 2 D.PREPARER. - . Kimbedy A.Lewis Office Manager Preparer of the Sales Disclosure Form Title 226 W.Broadway Broadway Title,Inc. Address(Number and Street) Company Princeton,IN 47670- 812-386-1687 kin-bti@insightbb.com City.State,and ZIP Code Telephone Number E-mail E.SELLER(S)/GRANTOR(S) _ - - - - ... - - . _ ' - ' . . Michael L.Eichmiller Victoria L.Eichmiller Seller I-Nume as appean an cons ante document Seller 2-Name us appears on com'tyonce document 196E780S 196E780S Address(Number and Street) Address(Number and Street) Fort Branch,IN 47648- Fort Branch,IN 47648- Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and mplete as re aired y law,and is prepared in accordance wit -1.1-5.5,"Real Pro erty Sal? sclosure Act". Signature o .Seller c .ot'�e�`Seller (fl13,4c1 L, C - t .1,n, //P- 14,311 ) V1 - lc, L - oVA1 (II2d'bblE313 PdmrA N",.,.nfC"ILr SI-,,Mr.rasrmnrrvnn Prnbd gum.dCaller O-,n-•.nro,"r msro F.BUYER(S)/GRANTEE(S) APPLICATION:FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT-APPLY 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 CONDITIO, © ❑ 1.Will this property be the buyer's primary © ❑ 3,Homestead residence? Provide complete address of primary IrD 4.Solar Energy Heating/Cooling System residence,including county: 196 E 780 S ❑ © S.Wind Power Device Address(Number and Street) ❑ ❑ 6.Hydroelectric Power Device Fort Branch,IN 47648 GIBBON ❑ © 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ 0 2.Does the buyer have a homestead in Indiana to be ❑ © B.Is this property a residential rental property? vacated for this residence? If yes,provide ❑ © 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. ((fl("f'}„r r Not available in all counties.) Address(Number and Street) ac,4 et "19 —aQ3-1001• a3(C—bob City State ZIPCode 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 information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is 11 Will C4f � Sr JBUyrr1 Ssgna re a(BUyer2/S use • (aChe\ S.ke ( I (19113i13 //�/ /fie// 6/i�/�