Homestead_Faraone (2) ,.s- ,
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D:PREPARER ,
Laura Rininoer Closing Coordinator
Prepare of the Saks Disclosure Form Title
7820 Eagle Crest Blvd Ste 201 Reaional Title Services. LLC
Address(Number and Street) Company
Evansville, IN 47725 812-759-5555
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S) .. -
Roy H Name Roethemeier Mildred F mnethemoiPr T"1$j F D
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance doav 1
504 W SR 68 504 W SR 68
Address(Number and Street) Address(Number and Street)
Haubstadt IN 47639 Haubstadt IN 47639 SEP 0 4 7013
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowlQ3t N 06 19PAISDRORrt
and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
yjE X/e.46 a 40cez t,d 4ii/F r 4(g .j aeb( 11�4c,t '�
gnature u Seller / Signature of Seller /4//7 ti
Roy H.Roethemeier by Jean Ellen SchmittAlF 8/30/2013 Mildred E. Roethemeier by Jean Ellen Schmitt 8/30/2013
Printed Name of Seller Sian Date(MM/OD/Y111) Printed Name of Seller Sian Date(M.M/DD/1TYp
LF.BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY.TAX-DEDUCTIONS r.IDENTIFY ALL ITEMS THAT APPLY• . .:
Dominic E. Faraone Justine L. Faraone
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears un conveyance document
119 N.Race St. 119 N. Race St.
Address(Number and Street) Address(Number and Street)
Haubstadt. IN 47639 Haubstadl, IN 47639
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I YES NO CONDITION
12 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary ❑ 0 4.Solar En / m
residence,including county:
El IS S.Wind Pm iESree2v r
504 W SR 68 Y
'Address(Number and Street) ❑ SI 6.Hydroele c over Device
Haubstadt,IN 47639 Gibson ❑ Q 7.Geothermal Ens&HealaUlooling Device
City,State ZIP Code County J
El /%1 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rental t roperty?
vacated for this residence? If yes,provide ❑ Fl 9.Would you like( reee.d' ..g tatements for this
complete address of residence being vacated, property via e-r•: ": - bee tffjR(ormation
including county: below.P 4A'�LienSfrmoreinformation
information.
Not available in all counties.)
Address(Number and Street)
?!o-22-o I -ZO Z X395 oo ?
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
being-filed.)
Signature of Bu rI azure of Buyer? pause
u . . .t.- I Juatne L Faraone 8/30/9013