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Homestead_Dolletzki
'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 812-768-5800 kharbison @esbanc.com City,State,and ZIP Code Telephone Number E-mail E.SELLERS)/GRANTOR(S)t ' -- _•. - - - , Diana S Beatty Individually Diana S Beatty Attorney-in-Fact for David J Spindler Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 108 S Campbell Blvd 7435 Five Points Rd Address(Number and Street) Address(Number and Street) Haubstadt IN 47639 Indianapolis IN 46259 Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct ane(.Fomplete as required by law,and is prepared in accordance wit IC 6-1.1-5.5,"Real Property Sales Disclosur-Act". f �,57(,Git td.)kr. /�. - .I-...s ;,. .L/ t o --. L' /%..A_ /. 'I. Signature ofSe I]er Signature of Seller Diana S Reattv Individually 09/12/2014 Diana S Beatty Att-in-Fact for David J Spindler 09/12/2014 Printed Name ofSeller Sian Date(MM/OD/YYYI] Printed Name of Seller Sian Date IMM/DD/YYYI] F.BUYERS)/GRANTEE(S)-APPLICATION'FOR PROPERTY-TAX DEDUCTIONS--IDENTIFY-ALL ITEMS THAT APPLY-- _-- - - s Dana M Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document 431 S West St Address(Number and Street) Address(Number and Street) Haubstadt. IN 47639 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 Ill ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: ❑ O 405 S West St 5.Wind Power Device Address(Number and Street) ❑ 0 6.Hydroelectric Power Device Haubstadt IN 47639 Gibson ❑ [Z] 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ El 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 ❑ Z 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) a(4)-aa-DIaoa-000 - S 9-0DR City,State ZIP Code County Primary property owner contact name E-mail