Homestead_Karcher INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
:D..PREPARER - - - -- - -
Amber Messmer Closer
Preparer of the Sales Disclosure Form Title
606 Main St Dubois County Title
Address(Number and Street) Company
Jasper. IN 47546 812-482-1696
City,State,and ZIP Code Telephone Number E-mail
_E:SELLERSSI/GRANTOR(, ---- . • - - _ - __
I. -. . :- u' u t. n-e-
®t-N'amea pears on conveyance document Seller 2-Name as appears on conveyance document
Purr .Sf
A dress(N ber and Street Address(Number and Street)
QLLbStOd-t .70 47 11,0g
Telephone Number E-mail
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
an `co e as req i.e. by I.,a • is prepared in accordance with IC 6-1.1-5.5,"''al Property' Sales Disclosure Act".
A.% \ 1 C gill L._�i V aw �0. -
SignatureofSeller Signature of eller
•.. '• . :. •."•- Misty M. Rathgeber 8/14/13
Printed Name a SeL!s - Sian Date(MM/DO/nTY) Printed Name of Seller Sign Date(MM/oO/riYY)
-F C..' R S GRANTEES ,_APPLICATIO C• 'ROPERTY.TAX-DEDUCTIONS=IDENTIFY ALL ITEMS THAT APPLY __- --
_
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Buyer 2-Name as appears on conveyance document
Ti . ewe -
ess(Number and Sweet) Address(Number and Street)
0., G.At N L 1(,39
Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR T ' ' LL OF THOSE THAT APPLY.
YES NO CONDITION • •�•
�❑ 1.Will this property be the buyer's primary IN . • •
residence? Provide complete address of primary ❑ 115 4.Solar Energy Heating/Cooling System
S residence,including county:
C CO-)0 ❑ 07 5. . o er vi e
Address(Number and Street) /• I Ofl ❑ 6. t .r.{'I trl l' I�o'Ice
/1.--•t Li , ❑ 7.Geo,o- al Energy Heating/Cooling Device
C ,State ZIP Code County I'
❑ 2.Does the buyer have a homestead in Indiana to be ❑ 7,4 6.Is thi of )2Ot3sidential rental property?
vacated for this residence? If yes,provide ❑ 7 9.Would you like to receive tax statements for this
complete address of residence being vacated, prop via rovide contact information
including cou • beloructio s for more information.
'--S 5 1p 5 I C I ra\ k c1n 6 NxXd rico
-d rest(Numbs and Street D
.L. _ • . .O - - , N ) ! CIS -43 -o/-acn-cna. / 2� a Ce
City,State ZIP Code County
Primary property owner contact name E-mail