Homestead_Gross (2) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
Karen S.Creek Closing Agent
Preparer of the Sales Disclosure Form Title
501 Main Street.Suite 101 Bosse Title Company
Address(Number and Street) Company
Evansville,IN 47708 812-421-4000 karen.creek @ieffbosse.com
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S)_
Thelma M Seib Thelma M Seib Co-Trustee
Seller I-Name as appears on conmyance ument Seller 2-Name as appears on conveyance document
1706 r . , d /fig /766 L Si id /6 8-
Address(Number and Street) �/ Address(Number and Street)
AI Brame �7lo1' Ft Brant)- .col v-7“'$
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
an c mplete as required¢y law,and 's prepared in accordance wit IC 6- .1-S.5,"Real Prope Sales Disclosure Act"
Signature d Sell iNYC p-�/- �t�->� -- �� .�
f ,g nature of Seller
Thelma M.Seib u'-I'' ThelmaM Seib,Co-Trustee -1- 2_2....%-f�"
Printed Name of Seller Sign Date(MM/DO/YYYYI Printed Name of Seller Sign Date(MM/OD/rvn)
F.BUYER(S)/GRANTEE(S)'cAPPLICATION'EORP,ROPERTY,.TAX,DEDUCTIONS-IDENTIFYALL'.ITEMSTHATAPPLYr:i _ - __ :,7
Diane M.Gross
Buyer l-Name as appears on conveyance document Buyer 2-Name as appears a • ante document
524 W.St Rd 68 D
Address(Number and Street) Address(Number and5tree
Haubstadt,IN 47639
_AUDIT
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF 7p{76E THAT PL'.
YES No CONDITION property buyer's P ry I ES ❑ 3.Homestead® NCOUP y R
Ti ❑ 1.Will this be the rima
residence? Provide complete address of primary ❑ Ti 4.Solar Energy Heating/Cooling System
residence,including county:
e)- 1 N) �S T K r1 t,Y ❑ Ti 5.Wind Power Device
it press(Number and Street) ❑ Ti 6.Hydroelectric Power Device
ri a IA:bsi Jr/4- %n 9 q 7 3 / ❑ Ti 7.Geothermal Energy Heating/Cooling Device
I
City,State 7IP Cade County
❑
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 Li Ti 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) ��ss,�ss
City,State ZIP Cade County 210 —ZZ -O I -201 • Ooo34,2 oo9
Primary property owner contact name E-mail