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HomeMy WebLinkAboutHomestead_McEllhiney INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 - D:PREPARER -- -- Karen Harbison VP Preparer of die Soles Disclosure Form Tide 803 E State Rd 68 Haubstadt State Bank Address(Number and Street) Company Haubstadt IN 47639 812-768-5800 kharbisont esbanc.com City.State.and ZIP Code Telephone Number E-mail E..SECLER(S)/GRANTOR(S) :- Shane A McFllhiney Randi M McElhiney Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 4693 S 1025 F g15Ci Ea 5-1- -700 5.7 d4in. Address(Number and Street) Address(Number and Street) Oakland City IN 47660 atk(aAC4 c:41 a 1,4 47(4,o Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct a d complete as�equired b law,and is prepared in accordance with IC 6-1.1-5.5,"Real SaKs s,DDis�Jclosure Act". Signature of Seller Signature of Seller y Shane A McEllhiney et-73 .-/1 Randi M McEllhinev 7-1 3- ( Name of Seller Sian Date IMM/DD/IYIYI Printed Name of Seller Sian Date(MM/OD/Mil I-F..BUYER(S)/GRANTEE(S)--APPLICATION.EOR.PROPERTYTAX.DEDUCTIONS-_IDENTIEYALLITEMSTHATAPPLY _ _ _ __ Shane A McEllhinev Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document 4693 S 1025 E Address(Number and Street) Address(Number and Street) Oakland City.IN 47660 Telephone Number ITT�TT E-mail TILE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS t PROPERTY. IDENTIFY ALL OF THOSEI PL J iT YES NO CONDITION 0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heatik4o2lagontem residence, including county: ❑ 4693 S 1025_E 5.Wind Power Device Address(Number and Street) ❑ 0 6.Hydroelectric Po f Dev' p , As -"Enna. Oakland City, IN 47660 ❑ 0 7.Geothernt(�Ij'a�ryyy ?A 1 I ma Device City.State ZIP Code County AUDITOR ❑ 0 2.Does the buyer have a homestead in Indiana to be ❑ 0 8. Is this property a residential rents 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) ab -a0 {13-Joi-Oa) 'a col 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 information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is ing filed.) Signature of Buyer] Signature of Buyer2/Spouse Shane AMrFBhiney S5 j3-(3 -' Number License/ID/Other Number