Homestead_Money • INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D.PREPARER - - • 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 8127685800 kharbisoneesbanc.com City,State,and ZIP Code Telephone Number E-mail E:SELLERS)%GRANTOR(S) - - - - - '. - --° - Thomac F Michelson Debora M Michelsen Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 315 Terrace Avenue 115 Terrace Avenue Address(Number and Street) Address(Number and Street) Pismo Beach CA 93449 Pismo Beach CA 93449 Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and ccAnplete as re`tquired bylaw,and 's prepared in accordance with/ -1.1- eal Prgpe Coles Di osure Act". Signature of Seller �/ Signature ofSeller /V� �/ Thomas E Michelsen 6 -°Z 3-20/t( Debora M Michelsen �jV//1 Printed Name ofSeller Sian Date(MM/DD/YYn') Printed Name of Seller ??y-� -r- N/DDryriYI F.BUYER S /GRANTEE(S).-APPLICATION-FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALLITE F(hT 1PPL . arry W Monet/ Dori L Monet/ e a.q.r,-u.,,Tea pears on conveyance document Buyer 2-Name as appears on conveyance document 995E 925 S 995E 925 S JUN 3 0 2014 Address(Number and Street) Address(Number and Street) Ft Branch. IN 47648 Ft Branch IN 47648 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 ❑ ❑ 1.Will this property be the buyer's primary ri Q ❑ 3.HomesteaT residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: ❑ ❑ 5636 W 800 S 5.Wind Power Device Address(Number and Street) ❑ 0 6.Hydroelectric Power Device Owensville. IN 47665 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County 0 ❑ 2.Does the buyer have a homestead in Indiana to be ❑ 0 8.1s this property a residential rental property? 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. 995 E 925 S Not available in all counties.) Address(Number and Street) Ft Branch. IN 47648 Gibson 1 , _ R_ /9 _ x(00 - bore? ) - X1.5 City.State ZIP code County Primary property owner contact name E-mail