Homestead_Whitten (2) 1
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
IFD31 REPARER �_� - -
KAREN HARBISON VP
Preparer of the Sales Disclosure Form Title
803 E STATE RD 68 HAUBSTADT STATE BANK
Address(Number and Street) Company
HAUBSTADT IN 47639 812-758-5800 kharbisoneesbanc.com
City,Stare,and ZIP Code Telephone Number E-mail
'T>SELLER(S)%GRANTOR(ST,___ ___ _
J W CI EVFI AND AS TRUSTEE I INDFR THE RFVOCARLF DFCI ARATION OF TRUST AGREFMFNT OF J W CLEVELAND DATFD
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
3443 W SR 88 MAY 3RD 1999
Address(Number and Street) Address(Number and Street)
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 prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
_mot n to (�eee,p-ye1/40 aAiu&[e.
`/Signature of Seller Signature of Seller
J W Cl EVFJ AND TRUSTEE 4/21/2015
Printed Name of Seller Sian Date(MM/DD/YYYI) Printed Name of Seller Sian Date(MM/OD/YYYr
LF.;BUYER(S)/GRANTEE(S)=APRLICATION;FOR. ROP,ERTI:TAXtDERUGT IONSZ1DENTIF,VARLITEIC1S_THATAP:PCY -
SEAN MICHAEL WHITTEN LYNDSEY L WHITTEN
Buyer l-Name as appears on conveyance document Buyer 2-Name as appears on conveyance dr--^• t
4180W850S 4180W850S
Address(Number and Street) Address(Number and Street)
FT BRANCH IN 47648 FT BRANCH IN 47648
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT "
YES NO CONDITION I YES NO CONDITION GIEISON �OUNT AUDIT
1Z ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary ❑ 2 4.Solar Energy Heating/Cooling System
residence, including county:
W 1050 S ❑ IN 5.Wind Power Device
Address(Number and Street) ❑ 2 6.Hydroelectric Power Device
HAUBSTADT IN 47639 GIBSON ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
0 ❑ 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 ❑ 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.
4180 W 850 S Not available in all counties.)
Address(Number and Street)
HAUBSTADT IN 47639 GIBSON Z10-7_Z—o9 — 2.-00 002. /c ) O7
Ciry,State ZIP Code County
Primary property owner contact name E-mail