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Homestead_Keil (2)
• INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 KAREN HARBISON VP Preparer of the Sales Disclosure Form Title 803 E STATE HWY 57 HAUBSTADT STATE BANK Address(Number and Street) Company HAUBSTADT IN 47639 812-768-5800 kharbison(EEesbanc.com City,State,and ZIP Code Telephone Number E-mail MATTHEW LEE KEIL Seller I-,Name as appears on conveyance document Seller 2-Name as appears on conveyance document 3853 F 900 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 complete as required by law,and i prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". A /�G eY° /r' Signatureof Seller Signature of Seller MATTHEW I EE KEIL 09/04/2015 Printed Name ofSeller Sian Date(MM/DO/M11 Printed Name ofSeller Sian Date(MM/DD/YYYYI F.BUYER(S)/GRANTEE(S)_.APPLICATIONFORPROPERTYTAXDEDUCTIONS IDENTIFYALUITEMS_THATTAPPLY _ ___, MATTHEW L KEIL AMANDA R KEIL Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document 3853E 900 er 3853E 900 S Address(Number and Street) Address(Number and Street) _ HAUBSTADT IN 47639 HAUBSTADT IN 47639 • TIIE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION I YES NO CONDITION r • 0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead N COUNTY AUDITOR residence? Provide complete address of primary ❑ © 4.Solar Energy He�Ut E1loling System • residence,including county: ❑ 3853E 900 5 S.Wind Power Device Address(Number and Street) ❑ 0 6.Hydroelectric Power Device HAUBSTADT IN 47639 GIBSON ❑ Ei 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ Z 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 ❑ 1 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) 24- / 9 - Z 1- 300 oo1. v(9- 0o5 City,State ZIP Code County Primary property owner contact name E-mail