Homestead_Brock INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
DsPREPARER` , ^ r: .
KAREN HARBISON VP
Preparer of the Sales Disclosure Form Tide
803 E STATE HWY 68 HAUBSTADT STATE BANK \
Address(Number and Sweet) Company \i
HAUBSTADT IN 47639 8127685800 kharbisonr esbanc.com
CIRS State,and ZIP Code Telephone Number E-mail
:E SELTTER(5I%GRANTOR5)F` - __..,•, .- •— — - --- ----- . -- -- - - ----
AARON M CHURCH _
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
10410 SOUTH PHEASANT RUN
Address(Number and Street) Address(Number and Street)
HAUBSTADT IN 47639
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and co lete as requir by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
I Signature of Seller-- -A Signature of Seller
AARON M CHURCH 03/26/2014 _
Printed Name of Seller Sian Date(MM/OO/YYM Printed Namgof feller Sian DatelMM/OD/rrrvl
P.'BUYER($]GRANTEE(S),_APPLICATIONIE,OWROPERTY TAX�Dq,'y_enONS ;IDENTIF,YYAL hfS!THAT'APP,LY�t _� _
. ( ADAM JOHN BROCK COURTNEY LEE BROCK•, -- -.• • : •nveyonce document Buyer 2-Name as a.y•. • - .eyunce document
12911 COLD •TER DR 12911 COLDWATER DR
Address(Number and Street) Address(Number and Street)
EVANSVILLE IN 47725 EVANSVILLE IN 47725
TILE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF TIIOS I - . P 4
YES NO CONDITION • NO CONDITION I g®e
Q ❑ 1.Will this property be the buyer's primary , 0 ❑ 3.Homestead
residence? Provide complete address of primary\..._.... n •. • - 'nergy Heatip9 o9liftis em
residence,including county: ❑ IYIH� 31-LUI
10410 SOUTH PHEASANT RUN S.Wind Power Device
Address(Number and Street) ❑ Q 6.Hydroelectric Pow Deyic
HAUBSTADT IN 47639 GIBBON ❑ o 7,Geothermal Ener rig Device
1
Ciy,State ZIP Cade County uIB$ CDUN
IJ✓ ❑ 2.Does the buyer have a homestead in Indiana to be
❑ Q 8.Is this property a resld"ennai eR lti9r ty?
vacated for this residence? If yes, provide ❑ [ 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.
12911 COLDWATER DR Not available in all counties.)
Address(Number and Street)
• EVANSVILLE IN 47725 VANDERBURG ct -7J_J' _ SW- ooa.19S- oaV
City,State ZIP Cade County
Primary property owner contact name E-mail