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. INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER - - -- - -- ------JC - - - - -- '---C--- " 7--. Y-TT-%a3---:-fI* L----c7--77X----—7- . -- -•--;-77-7-7 1---'—---1 .---=-------,.'—..,i
_ _ . _____ . ,__
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 8127685800 kharbison@esbanc.com
City,State,and ZIP Code Telephone Number E-mail
Mark D Miller Brianna M Miller
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1916 S Walnut Lane 1644 Autumn Ridge
Address(Number and Street) Address(Number and Street)
Evansville IN 47714 Haubstadt IN 47639
Under penalties of perjury, thereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
atuaCe,72 glaw,and is prepared in accordapcMIC 6-1.1-5r5i3V1 Pitytpieorty Sales Disclosure Act".
Signature of Seller Signature of Seller
Mark D Miller 08/31/2015 Brianna M Miller 08/31/2015/
Printed Name of-Seller Sian Date[MM/DD/nill Printed Name&Seller Sian Date f MN/DWYYril
F.13,1131-807GRAKI-T8E(S)rfAPPLICATION,FORTROPERTYJAX DEDIJET-latiSff-LIMENTIEY.ALL ITEMS,THAT:APPILY
Jeremy S Mayer M lissa C Mayer )
Buyer!'Name as••: arson conveyance document ' Buyer 2-Name as rerA on conveyance document
411flaisi 11 St 403 E Mulberry St iY414
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 APP,n,1/4
YES NO CONDITION __,-.1.TrS- NO CONDITION CO/,
0 9 1.Will this property be the buyer's primary . IZI 9 3.Homestead lem
residence? Provide complete address of primary II p 4.Sol rgy Heating/Cooling System 'it
residence,including county: 0
0 g S.Wind Power Device
1644 Autumn Ridge
Address(Number and Street) 9 z 6.Hydroelectric Power Device
Haubstadt IN 47639 Gibson 0 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
0
9 z 8.Is this property a residential rental property?
9 2.Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide 9 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.)
403 E Mulberry St
Address(Number and Street)
Fort Branch, IN 47648 Gibson X-43-X-pc00-0007. t79'2-007K
City,State ZIP Code County
Primary property owner contact name E-mail
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