Homestead_Sives INDIANA SALES DISCLOSURE FORM SDF ID: Pa'ge 2
f):PREP CRER— — -- _
KAREN HARBISON VP
Preparer of the Sales Disclosure Form Tide
803 E STATE HWY 68 HAUBSTADT STATE BANK
Address(Number and Street) Company
HAUBSTADT IN 47639 8127685800 kharbison @esbanc.com
City,State,and ZIP Code Telephone Number E-mail
E.SELLERS)%GR 1NTOR(S)` _ _-- __ -- __ _—_ - -- — ---.
FAG! F I IMITFO I IABII ITY COMPANY
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
9753 E 450 S
Address(Number and Street) Address(Number and Street)
OAK/AND CITY IN 47660 -
Under penalties of erjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and-eompl ' qui ed by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
7
Signature of Seller Signature of Seller
RICHARD FALLS MANAGER '6-1a-14
Printed Name of Seller Sian Date pw/DO/YY1'Y) Printed Name of Seller Sign Date(MM/Da/YYYYI
. _• -• ,- ':VTEE(S)!=-APPL'IGATIONFOR P:ROPERTYtiTAX<.DEDUGT16NS=IDENTIFYEACGiTEMSTH'TTAPPEY;__ -. . ,
0 MARY H SIVES
Buyer 1-Name ac^,,,ears on conveyance document Buyer 2-Name as appears on conveyance document
2 : ' -•--ISON
Address(Number and Street) Address(Number and Street)
OAKLAND CITY IN 47660
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR Tills PROPERTY. IDENTIFY ALL OF TIIOSF.TH A•• .
YES NO CONDITION I NO CONDITION •
0 ❑ 1.1Nill this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary - I • . _ ,Whi gwteLn
��� � • � -eating I g
residence,including county: ❑ 5.Wind Power Device'
871 N POLK DR
Address(Number and Street) ❑ 0 6.Hydroelectric Power 1r7 vice a ,;
ge1717ii
OAKLAND CITY IN 47660 GIBSON ❑ 0 7,Geothermal Fo 'l, : ••. a hey t: F evicep
City,State ZIP Cade County DITO')
❑ 0 2.Does the buyer have a homestead in Indiana to be ❑ 8.Is this property a residential rental 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)
00-/0-/2- do/- 400, c/6- 067
City,State ZIP Code County
Primary property owner contact name E-mail