Homestead_Toth (4) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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Karen Harbison VP
Prep°rer of the Sales Disclosure Form Tide
803 E State Rd 68 Haubstadt State Bank
Address(Number and Street) Company
Haubstadt IN 47639 812-768-5800
City,State,and ZIP Code Telephone Number I Email
Kalman M Toth Christine M Toth I
.Seller I-Name as appears on conveyance document Seller 2-Name as appears on con veyonce'document
6861s500W 1010S Center St
Address(Number and Street) Address(Number and Street)
Ow nsvillP IN 47665 Ft Branch IN 47648
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
an�d)�com�plete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
K ('i1vle-,— it�1- -7:9-71,-, @S VM-` Act .°` \
Signature of Seller Signature of Seller
Kalman M Toth 11/26/2013 Christine M Toth 1 11/26/7013
Printed Name of Seller Sian Date rM.M/DD/YVYYI Printed Name of Seller I Si,;,,Date iuM/Da/Ytnl
_F;=.. '-- • EES APPLIGATIOh_FORP?P,ROP.ERTYLTAXyDEDU.CT10ASrIDENTIFl;ALEiITEh1S:THATtt1PPLY
d 1 Kalman M Toth
Buyer I- '-' . s appears on conveyance document Buyer 2-Name as appears on conveyance document
6861 S 500 W
Address(Number and Street) Address(Number and Street)
Owensville IN 47665
Telephone Number E-mail
TIIE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
I
YES NO CONDITION I YES - • _
I0 ❑ 1.Will this property be the buyer's primary 1 0 ❑ 3.Homestea. I' I !.i
residence? Provide complete address of primary = 4.Solar Energy Heating/Cooling System
residence, including county: I
❑
6861 S 600 W IN 5.Wind Power DeviceDEC 9 -2013
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Owensville,IN 47665 ❑ Q 7.Geothermal Energy `, atin_-..tale evice
City,State ZIP Code County I IP ' "1rrn1.
❑ IZ 8.Is this prope�-t�t• . -.66 .t4 . ?
❑ IA 2.Does the buyer have a homestead in Indiana to be OR
vacated for this residence? If yes,provide ❑ 9.Would you likelto 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) !
City.State ZIP Code County
at/e /9/ 3 Cb-Cn 3zi?-oo
Primary property owner contact name I E-mail