Homestead_Meny,_
INDIANA SALES DISCLOSURE FORM SDF ID Pa e 2
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!D.PREPARER - -'°`- .�__ ':-. _... _�_ __. _ -: -: -n �"����_�..._.__,. _ - - __,.__ <a�� __ __:. - _,
KAREN HARBISON VP
Preparero/Ne Safes D"uclosure Form TiUe
803 E STATE HWY 68 HAUBSTADT STATE BANK
Addr�(h'umberand5veet) Comyany
HAUBSTADT IN 47639
E�mail
E. SELLER S GRANTOR S _::_ _ . _ ' `� ' � r - � -
w .
ADAM J MFNV RANDAI I R MFNY 8 MARY S MENY
Sefler 1� Nome as appears on ronveyanre dxument Selle� 2- Name as appears an ronveyance doaumm[
17749 S 50 W fi65 W 1?00 S
Addrw(NUmberand5treelJ Add�¢t(Numberand5vee[J
HAUBSTADTIN47639 HAUBCTADTIN 47R39
Ciry.Smtt, andZlP Cade Ciry, Srate, and ZIPCOde
E�mail
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and compl�e e as �re �r�efdnby/ law, and is prepared in accordance wi�th jIC 6-11-S.S, "Real Proper[y Sales Disclosure Ac[".
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Sigmmrcoffrlfer Sjgnam�eoJSeller �
ADAM I MFNY 12/23l2015 (
PdnredNumeo(Se!le� SionDate(MM/DD Pnn[edNameo(Seller Sio Dal M/OD
F�BUYER 5 GRANTEE S.='AP.EGICATION:FOR'BROPERTYTAXDEDUGTIONS-IDENTIFY:ALL-I MS ' P "-
ADAM MENY ARAH E MENY
Bu' - pearsonronveyancedocument asappearsomm�veyanced ^�31 2015
11749 S SO W 11749 � 50 W
Addres(h'umberandSVeetJ Address(Num6erand5treet) /���
HAUBSTADT IN 47639 HAUBSTADT IN 47639 h�
Ciry,Smce.andZ/PCode Ciry,Smle,andZlPCade ONCOUNTYAUDITOR
E-mail
THE SAI.FS DISCLOSURE FOMf AIAY BE USED TO APPLV FOR CERTA W DEDURIO�S FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YFS AO CO\'DITIOY
� ❑ 1. 4Vi11 this property be the buyer's prima 0 ❑ 3. Homes[ead
residence? Provide complete address o rimary , ng/Cooling Sys[em
residence, including county:
0✓ S. Wind Power Device
11740 C SO W -
Address(Num6erand50-eet) ❑� 6. Hydroelectric Power Device
HAUBSTADT IN 47639 GIBSON � Q 7, Geothermal Energy Hea[ing/Cooling Device
Ciry, Smre ZlPCade Counry
❑ � 2. Does [he buyer have a homes[ead in Indiana [o be � � 8• �s this property a residentlal ren[al property?
vacated for this residence? If yes, provide ❑ � 9• Would you like [o receive tax statements for this
comple[e address of residence being vacated, property via e-mail? (Provide contact informaCion
induding county: below. Please see instruc[ions or more in�ormation.
No[ available in all counties.)
Address (Number and Svee[J
�� _ a.� -/,i - aoo -oo!• 833-0 �y
Ciry.SmteZlPCode Coun �
'mary property owner ronm¢ name
Under penalties of perjury, I hereby cerdfy that this Sales Disdosure, to the best of my knowledge and belief, is true, correct
and tomplete as required by law, and is prepared in accordan[e with IC 6-11-5.5, "Real Property Sales Disclosure Ac[". (Note:
Spouse information, Social Security and Driver's License/Other numbers are no[ necessary if no Homestead Deduction is
being filed.) '
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SignaNrco(Bvyerl 5 amreo%Buyer2/Spouse
nnene 1 MFNV 12I23I7M5 C�RSf-I F AAFNV 12/2�/7015
PAnredLegalNameoJBvyer] SignDa¢(MH/�0/YYY17 PnntedLegalNameofBuyer2/Spouse SignDate(MM/00/rYY1)
LastSdigiao�BuyerlDriver's 5[ate Las[SDigitsafSotial5ecurityNumber LastSdigifsafBuyer2/SpouseDriver's Smte Las[SDigiCCOfSocialSecurity
Lirense/lD/0[herNumber Number License/ID/OtherNumber
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