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DISCLOSURE INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D::PREPARER,
M.Teresa Fruit Title Services
Preparer al the Sales Disclosure Form Title
501 Main Street,Suite 101 Bosse Title Company
Address(Number and Sheet) Company
Evansville, IN 47708 (812)421-4000 teresa.fruit(dieffbosse.com
City,State,and ZIP Code Telephone Number E-mail
E.SEI LER(S)%GRANTOR(S)• - . - --- - --- - • _ _ - _ . .
George F Hasselbrinck
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
3727 Country Ln
Address(Number and Street) Address(Number and Street)
Brownsburg IN 46112
Under penalties of perjury,l 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 prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
in
Sigture of Signature of Seller
George F Hasselbrinrk U
Printed Name of Seller Sion Date(H.M/aD/YYYY) Printed Nome of Seller Sian Date(HM/DD/YYYI)
)P BUYER(S)/GRANTEE(S).-APPLICATION,EORiPROPERTYTAXOEDUCTIONS
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR TIIIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I YES NO CONDITION 11r l ( 9014
Q ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heati'j a/C� m°S e
residence,including county: ❑ Vim'. �-1 . r
SI
3529 F 250 S 5.Wind Po`VTIVSVFPCOLINTY AUDITOR
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Fransisco, IN 47649 Gibson ❑ is 7.Geothermal Energy Heating/Cooling evice
City,State ZIP Code County
❑ is 2.Does the buyer have a homestead in Indiana to be 111 8.Is this grope pcesi ntal p operty?
vacated for this residence? If yes,provide ❑ 12 9.Would you li e tb-receiv tax s me' is 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) %S
- lc, 0. 6 - loo - COO 0?19-00
City,State ZIPCode County
Primary property owner contact name E-mail