Loading...
HomeMy WebLinkAboutHomestead_Leukhardt INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 _D,PREPARER _ - _ _ - - - - - -- KAREN HARBISON VP Pre pa rer of the Sales Disclosure Form Tide 803 E STATE HWY 68 HAUBSTADT STATE BANK Address(Number and Street) Company HAUBSTADT IN 47639 8127685800 kharbison @esbanc.com City.State,and ZIP Code Telephone Number E-mail ;E:SEL ER(S)/GRANTOR(S) . — ,x.:_...:., – --– -–- __ –- -- - __ -- - --- J E R E M Y Y S MAYER MELISSA C MAYFR Seller 1-Name as appears on conveyance document Seller Z-Name as appears on conveyance document 403 E MUI BERRY ST 403 E MUI BERRY ST Address(Number and Street) Address(Number and Street) FORT BRANCH IN 47648 FORT BRANCH IN 47648 Under •enalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and mplete as re' ire. 8 law,and is prepared in accordance wit IC 6-1.1-5.5,"Real Property Sales Disclosure Act". /a s.. a L ay,,AA9c125---- •gnature of t% Signature of Seller IFRFMY S MAYFR 08/11/2015 MELISSA C MAYER 08/11/2015 Printed Name of Seller Sian Date(MM/oD/YYYYI Printed Name ofSeller Sian Date(MM/DOt/ n'i - --- - K E R R Y __ ___; KERRY D LEUKHARDT 1 NANCY E LEUKHARDT Buyer I.Name as appears on conveyance document Buyer 2-Name as appears on conveyance document 12501 S OWENSVILLE RD 12501 S OWENSVILLE RD Address(Number and Street) Address(Number and Street) FILE HAUBSTADT IN 47639 HAUBSTADT IN 47639 1 n I �I D THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THA PPLY. YES NO CONDITION YES NO CONDITION hOilt fl 0 ❑ 1.Will this property be the buyer's primary l71 Ill 3.Homesteag IBSON COUNTY AUDITOR residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: ❑ ❑ 403 E MUI BERRY ST 5.Wind Power Device Address(Number and Street) ❑ g 6.Hydroelectric Power Device FORT BRANCH IN 47648 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 ❑ g 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. 12501 S OWENSVILLE RD Not available in all counties.) Address(Number and Street) h�/_ HAUBSTADT IN 47639' GIBSON a 6i H - I D� -o0o t 69 �I.o b City,State ZIP Code County Primary property owner contaccname E-mail