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Homestead_Pohl
r INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 _D.P.REPARER _ .— _ s. - --- --- - - - - - KAREN HARBISON VP Preparer of the Sales Disclosure Form Tide 803 E STATE HWY 68 HAUBSTADT STATE BANK __ Address(Number and Street) Company HAUBSTADT IN 47639 812-768-5800 kharbison(@esbanc.com Ciry.State.and ZIP Code Telephone Number E-mail - _E:SELEER(S)/GRANTOR(SJ----- --- -- -- - — _�---- — ———— - TRAVIS WAYNF RUI CHFR Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 120W 975 S _ 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 corn ete as required by law,and is prepared in accordance with IC 6-1,1-5.5,"Real Property Sales Disclosure Act". Signature of Seller Signature of Seller TRAVIS WAYNF BULCHER 06/18)2015 Printed Name ofSeller Sian Date(MM/oD/YYYf Printed Name of Seller Sian Date(MM/DO/YYn1 F.,BUYER(S)/GRANTEE(S)_APPLICATI0Ni FOR-PROPERTY TAKDEDUCTIONS__IDENTIFY-ALL ITEMS_THATAEPLY___ - - .._- _�. RICHARD E POHL LISHA POHL Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document 1971 EAST STATE RD 68 1971 EAST STATE RD 68 Address(Number and Street) Address(Number and Street) HAUBSTADT IN 47639 HAUBSTADT IN 47639 $� THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE TAPPftY. YES NO CONDITION I YES NO CONDITION 'VV Z 2 20/5 0 ❑ 1.Will this property be the buyer's primary Q ❑ 3.HomeUte ad residence? Provide complete address of primary ❑ © 4.Solar Er l Enmity/0 a� , IA,,,Ar.- ystem residence,including county: ❑ ri 5.Wind Power Device NTYgV T 120W975S o, Address(Number and Street) ❑ Z 6.Hydroelectric Power Device O R 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 ❑ Q 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. 1971 EAST STATE RD 68 Not available in all counties.) Address(Number and Street) HAUBSTADT IN 47639 GIBSON 2. 6_, 9- 3 / /60 co / 730 1007 9 City,State ZIP Code County Primary property owner contact name E-mail