HomeMy WebLinkAboutHomestead_Campbell 'INDIANA SALES DISCLOSURE FORM SOF ID: Page 2
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L D..PREPARER-. - ------ — _.. . -
Karen Harbison VP
Preparer of the Sales Disclosure Form Tide
803 E State Hwv 68 Haubstadt State Bank
Address(Number and Street) Company
Haubstadt IN 47639 8127685800 kharbison(a)esbanc.com
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S)
Krystal D Campbell Russell W Eloers
Seller 1-Name as appears on conveyance document Seller 2-Name os appears on conveyance document
400 W Am P321 S 25 W
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 complete as required by law,and is pre oared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signatu eo Seller Signature of Seller
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Krystal D Campbell 09-22-2014 Russell W Eloers 09-22-2014
Printed Name ofSeller Sian Date(MM/On/M71 Printed Name of Seller Sian Date(MMIDD/YnYI
F.BUYER(SJJGRANTEE(S)-'APPLICATION FOR PROPERTY TAX DEDUCTIONS IDENTIFY ALL ITEMS THATAPPLY
Eric Campbell Krystal D Campbell
Buyer 1-Name as appears an conveyance document Buyer 2-Name as appears on conveyance document
400 Address W Elm 400 W Elm ��
ddJress(h'urnber and Street) Address(Number and Street)
Haubstadt IN 47639 Haubstadt IN 47 639
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. leg
YES NO CONDITION I YES NO CONDITION �i
❑ ❑ 1.Will this property be the buyer's primary ID 3. Homestead r�JON C U TTk(
residence? Provide complete address of primary ❑ a 4.Solar Energy Heating/Coolingc'st
residence,including county: 7TOq
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400 W Elm 5.Wind Power Device
Address(Number and Street) ❑ g 6.Hydroelectric Power Device
Haubstadt IN 47639 Gibson ❑ Q. 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ IN 2.Does the buyer have a homestead in Indiana to be ❑ B.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ R 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)
City,.State ZIP Code County 2-4-19 -31 303 000 046 009
Primary property owner contact name E-mail