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Homestead_Dix (4)
• INDIANA SALES DISCLOSURE FORM SDF ID: Paget %D.P,REP.ARER I-- 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 !ExSEL1.ER(S)%GRANTOR(5)_ '-- — 7::.-.. . . _... SFAN MICHAEL WHITTEN I YNDSFY I WHITTEN Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 4180W8505 4180W850S Address(Number and Street) Address(Number and Street) FORT BRANCH IN 47648 FORT BRANCH 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 complete as required by law,and is prepared in accordance wi h IC 6-1.1-5.5,"Real Property Sales Disclosure Act". t. / Signature o� t \ Sigma I o eller V SPAN MICHAEL WHITTEN 04120/2015 LYNDSEY L WH EN 0400/2015 Punted Name of Seller Sian Date IMM/DO/YY}1l Printed Name of Seller Sian Date IMM/DD/YMI !F::BUYER(S)/GfeANTEE(S) AP.FLIGATION(F ORPROPERTtYTAXWEDUGTIONS_IDENTIFYrALL1JIIEh1SETHAT;APPLY - JAYNELL LYNN DIX CHAD A DIX Buyer I-Name as appears on conveyance document Buyer 2-Name as appears an conveyance document 6756 S 225 W 6756 5 225 W Address(Number and Street) Address(Number and Street) FORT BRANCH, IN 47648 FORT BRANCH, IN 47648 THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE.THAT APPLY. YES NO CONDITION 1 YES NO CONDITION APR 2 3 2015 171 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Col �r- residence,including county: ❑ 0 5.Wind Power DevicGIBSON COUNTY AUDITOR 4180W 850S Address(Number and Street) ❑ 0 6.Hydroelectric Power Device FORT BRANCH. IN 47648 GIBSON ❑ 0 7.Geothermal Energy Heating/Cooling Device City.State ZIP Code County ❑ j� 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. -� S '` Not available in all counties.) i 4 5 �t w Address umber and Street) rt rcnLll l / i u 1 LY c C-:07C4 CV' 1g- - 3C©-(Da.38-mss City,Stare ZIP Code County Primary property owner contact name E-mail -