HomeMy WebLinkAboutHomestead_Higginson INDIANA SALES DISCLOSURE FORM SDF ID: Page 2.
tDdpREPARER:_
Karen Harbison VP
Preparer of the Sales Disclosure Farm Title
803 E State Rd 68 _ __ Haubstadt State Bank
Address(Number and Street) Company
Haubstadt IN 47639 8127685800 kharbisotesbanc.com
City,State,and ZIP Code Telephone Number E-mail
'E..SELLER(5)/GRANTOR(SJ— - --- -- —
Jeffrey D'Amico Janice M D'Amico
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
c-("1LI1 (11erlec -ad q"1qq tile rcer f -C(
ea Tess(Number and Street) Address(Number and Street)
I-)incicae■/ inn L( S IL,ej 7 ifl c ncy (11I t-( tile 9
Und penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and o .�e as required by law,and is prepared in accordance with .X1.1-5.5,"Real Property Sales Disclosure Act".
tS m re of Sesser Signa•r� Seller
Jeffrey D'Amico 06/13/2013 .1. •lu "'Amico 06/13/2013
Print. •'. - Sian Date(MM/DO/YYYY) nmea - Sian Date(MM/DD/Yri)1
'::UYER(S)/GRANT . 5)-APPLICATION.FOR`PROPERTYTAX= DUCTIONS=,IDENTIFYAL TEFISTHATAPPL'Y_- _____ _ _
4 Kellen C Higginson _ I Rochelle L H�inso
Buyer I-Name as ap•. on conveyance document -name as appears on conveyance document
fib rleber Dr 1.03 S Weber Dr
A• ' tuber and Street) Address(Number and Street)
Haubstadt IN 47639 Haubstadt IN 47639
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FORT ••.•ERTY. IDENTIFY- - HOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary lZ ❑ 3.Homestead
residence? Provide complete address of pri . • IN ICI • . _ --gy Heating/Cooling System
residence,including county: ❑
11245 S Brook Dr 5.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Haubstadt. IN 47639 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
Q ❑ 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.
103 S Weber Or Not available in all counties.)
Address(Number and Street)
Haubstadt IN 47639 Gibson �ad 3 aG -/cl(J-coo?
, a(7- Oa c7'
City,State ZIP Code County
Primary properry 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 n - . • s are not necessary if no Homestead Deduction is
being filed) / _____d ..51 nature of Buyer !' Signamr=ofBvyer2/Spouse 4
Kellen C Higginson 06/13(2013 Rochelle Higginson 06/1'+/2011