Homestead_Meny (15) INDIANA DISCLOSURE FORM SDF ID: I Page 2
A NA S ALES DISCL 0
Karen Harbison VP
Preparer of the Sales Disclosure Form Title
803 E State Hwy 68 Haubstadt State Bank
Address(Number and Street) Company
Haubstadt IN 47639 812-768-5800 kharbisoneesbanc.com
Ciry,State,and ZIP Code Telephone Number I E-mail
gr:SELLER(S)/GRANTOR(S)___ - - - -- - - — -- — — —)- — --- - .
Roger Dale Hyatt Argiree Hyatt(I ife Estate)
Seller]-Name as appears on conveyance document Seller 2-Name as appears on ronveyance'ocument
4444 Brandywine Dr 4444 Brandywine Dr
Address(Number and Street) Address(Number and Street)
Newburgh IN 47630 Newburgh, IN 47630
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
a complete as regui e by la v,and is prepared in accordance with IC 6-1.1-5.5,"•eal P oper• .les Discloser• Act".
Signature fSeller Signat'e of Seller j 'f V
Roger Dale Hyatt 10/30/2013 Argiree Hyatt 10/301201/
Printed Name of Seller Sian Dare rumooni'm Printed Nameo/Seller I Sion Dare IMM/00/i'nl
-F.BUYER(S)/,GRANTEE(S)-AP,PLICATION:FORPROPERTY:TAX•DEDUCTIONS±I DENTIFYAEL:ITEMStTHATAPPLY___=. __,
Nicholas J Menv Jamie A Meny
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
103 S Haven Dr 103 S Haven Dr I
Address(Number and Street) Address(Number and Street)
Haubstadt IN 47639 Haubstadt IN 47639
TIIE 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 I
0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homes g
residence? Provide complete address of primary ❑ 0 4.Solar Et�y ea •nog C in it em
residence,including county: ❑ 0 S.Wind P er v
102 S Campbell Blvd I p y�p
Address(Number and Street) ❑ 0 6. Hydroelectri vgy- /e2U1
Haubstadt,IN 47639 Gibson ❑ 0 7.Geothermal nergy leatmg/Cooling Device
City,State ZIP Code County I
❑ 0 8.Is this propertpa restd nti 11tsd property?
0 ❑ 2.Does the buyer have a
vacated for this residee homestead in Indiana to be I residence? If yes,provide ❑ 0 9.Would yomli statements for this
complete address of residence being vacated, prope>ta /To��ii h-rL�ftinformadon
including county: below.Please see instructions for more information.
103 S Haven Dr Not available in all counties.)
Address(Number and Street) ��11
Haubstadt IN 47639 Gibson 2 /to— /A-36 -1116)3 eon S��S oo 9
Ciry,State ZIP Code County I /
Primary property owner contact name Email
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