Homestead_Rexing (10) INDIANA SALES DISCLOSURE FORM SDI:ID: Page 2
D.PREPARER
KAREN HARBISON VP .
Preparerol the Sales Disclosure Form Title
503 E STATE HWY 68 HAUBSTADT STATE BANK
A Ij,-ess(Number and Street) Company
HAUBSTADT IN 47639 8127685800 kharbisonOesbanc.com
Cu',,'State.and ZIPCode Telephone Number E-mail
E.SELLER(S)/GRANTOR(S) .' -_ 1 17 -z „Y ,
VAN ROBINSON
Seller I-Name as appears on conveyance document Seller?-Name as appears un conveyance document
a1;1 S 19S W I
Address(Number and Street) Address(Number and Street)
FORT RRANCH IN 47648 _
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and col Ilete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
// //n�
ale Seller ts�
.ngnuuve of Seller Signaure o/Seller
VAN ROBINSON 01105/2015
Printed None of Seller Sian Date lsm/D0/1M1 Printed Name of Seller .Sion Date aW/OOp uIYI
F.8UYER(S)/GRANTEE(S) APPLICATION-POR•PROPERTYTAX.DEDUG7i0NS-'IDENTIFYALL:ITEMS THAT APE
MATTHEW M REXING •
''11 1�Fo A' i
Buyer I•;tome us appears on conveyance document Ru Ao,ne as appears on ro' ry 1 t t Ce for transfer----
15301 OLD PRINCETON RD Subie�ft
Address(Number and Street) Address(Number and Street) day(1
EVANSVILLE. IN 47725
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THE SALES DISCLOSURE.FORM MAY HE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALLOF/mo6G ttl 1•-' - -
YES NO CONDITION I ES NO CONDITIU '
L ❑ 1.Will this property be the buyer's primary I Q ❑ 3.Homestead
residence? Provide complete address of primary ❑ ❑ 4.Solar Energy Heating/Cooling System
residence, including county: ❑ O r. Power
6183 S 125 W 5.Wind ower Device
Address(,Number and Street) ❑ 0 6.Hydroelectric Power Device
FORT BRANCH- IN 47648 ❑ 0 7.Geothermal Energy Heating/Cooling Device
City.Store ZIP Cade Coon4'
❑ 0 2.Does the buyer have a homestead in Indiana to be
❑ 0 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 0 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.)
Aad,etc(.Number and Street)
. aco-is -4 a-Soo-coo. -oars
c,c,,State ZIP Code County
Primary property owner concoct name E-mail