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HomeMy WebLinkAboutHomestead_Pohl (4) • INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D:PREPARER- — .. — -- 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 8127685800 kharbison(o)esbanc.com City.State.and ZIP Code Telephone Number E-mail E.SELLER(S)/GRANTOR(S)_— _ — — _ JOHN K DYER TAMARA S DYER Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 13910 SPRING HOI LOW RD 13910 SPRING HOLI OW RD Address(Number and Street) Address(Number and Street) FORT WAYNF IN 46807 FORT WAYNE IN 46807 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 1 -L 1-5.5,"Real Property Sales Disclosure Act". (14�/le /a7-- Signature of Seller( a ,/ I Signaure of Seller / JOHN K DYER )n'N, I t A-+ 6 j 71 zz IS TAMARA S DYER (�' - —/- PrintedNameo(Selle Sian Date(11i1IM/DD/YYYYI Printed Name of Seller Sian Date(MM/DD/YYYY) F..BUYER(S)/-GRANTEE(S)._APPLICA ION:EOR PROPERTYtTAX DEDUCTIONSEIDENTIEY ALL'ITEMSiTHAT:APPLY. - — JAMIE L POHL Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document 702 S LINCOLN ST Address(Number and Street) Address(Number and Street) FORT BRANCH IN 47648 ILED THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION YES NO CONDITION J t:—41 0 ❑ 1.Will this property be the buyer's primary ❑ ❑ 3.Homest®f)3SON COUNTY AUDITOR residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: ❑ 0 5.Wind Power Device 801 F PARK ST Address(Number and Street) ❑ 0 6.Hydroelectric Power Device FORT BRANCH IN 47648 GIBSON ❑ 2 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ 0 2.Does the buyer have a homestead in Indiana to be El 8.Is this property a residential rental property? vacated for this residence? If yes,provide ❑ 2 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.) Address(Number and Street) City,Stare ZIP Code County Primary property owner contact name E-mail