Homestead_PfohlINDIANASALES DISCLOSUREFORM SDFID: Pa e2
�D.'PREPARER .rz: - t -' `' �.i ":�: °- r. • s'e`�F�:�:��_
Brvceann Cutsinqer
P�eparer a(the Sola D"udosure Form Title
226 W. Broadwav St. Broadwav Title, Inc.
AdO�ess (Number andS[reetJ
E-mail
°E.SELLER S GRANTOR S'; r v __ -_'_ := ". s`— : �z:, '"� �` � '.' �i_ „'.... ` '� '��.:Y
;.<1 -5.,.� 't� _ ci-�i'__
Anita F Tenbarge
Selier }- h'ame as appeors on conveyonre doaumm[ Seller Z- Name as appears om m�veyvnre dacument
_ 179 E. Hirsch Woods Ln.
AdC�ers (Numbe� and5treet) Addras (Nvmber and Sveet)
Hauhsta�lt IN 47FulH
Ciry, Sw;
E�mail Tele honeNvmber Email
Under penal[ies of perjury, 1 hereby certify tha[ this Sales Disclosure, to [he bes[ of my knowledge and belief, is [rue, correct
and complete as prequired bypl.a�w, and is prepared in accordance wi[h IC 6-1.1•5.5, "Real Proper[y Sales Disclosure Act".
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Slgnamrea(Seller � SignaNreo%Seller
MitaE Tenbarge ,�,�-.3/-/S
Pnn[edNomeofSelfer SionDa[e MM/OD PnnredNamea Seller SianDalefMK/oDM
.F.'BUYER S GRANTEE S "-AP,PLICATION'FOR'BRORERTYTAX DBDUCTIONS=,,IDENTIFY.:AI;I.I'fEMS_THATAPBLl _`;; '''�,i= ',_•::
Charles G. Piohl. Jr.
Bvyer 1- Name as appevrs on ronvryvnre dorumenl Bv,ver 1- Name as appevrs on ronveyance dxument
707 E. Laurel Ridge Ct. , ��
Addres (Number andSerreQ Address (Number and Slreetf
Haubstadt IN 47648 a �'•
Ciry.Sm[qandZlPCOde Ciry.Sm[e.andZlPCode L�^ `� 1
C�.
chuckp(ohl an.qmail.com 3 � �_
Tefeohoneh'um6er E�mail Tele honeh'umber %S E'-mall
THE SALES DISCLOSIIRE FORSf A1pl' BE USF.D TO APPLV FOR CERTAIY DEOURIOYS FOR THIS PROPERTY. IDEYTIFY ALL OF THO
YFS NO CO�DITIOY I }'�3 M1'O CONDITIOY NC
� ❑ 1. Will this property be die buyer's primary Q ❑ 3. Homestead �'q�,
residence? Provide mmplete address of primary � � 4. Solar Energy Heating/Cooling Syst ��TO �.
residence, induding county:
576 W SR 68 ❑ Q S. lNind Power Device
Add�¢s(Num6erand5tree!) ❑ � 6. t�lydroelectric Power Device
Haubstadt IN 47648 Gibson � 0 7. Geothermal Energy Hea[ing/Cooling Device
Ciry, Smre ZIP Code Lounry
❑ 0 2. Does [he buyer have a homestead in Indiana [o be � � $� �s [his proper[y a residential rental property?
vacated For this residence? If yes, provide ❑ � 9. Would you like to receive taac statements for this
complete address of residence being vacated, property via e-mail? (Provide contoct informotion
including county: below. Please see instrucfions%r mare injormation.
Not availa6le in afl rounCies.J
Address (Number ond 5[reetJ
016- �?-�-U/-�o�_p�. o�Gt�9
Ciry. Sm[e21PCode Counry.
Primary prvperty owner ron[oc[ name E�mail
Under penalties of perjury, I hereby certify [ha[ [his Sales Disclosure, [o [he best of my knowledge and belief, is true, correc[
and comple[e as required by law, and is prepared in accordance wi[h IC 6-1.1-5.5, "Real Proper[y Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/O[her numbers are not necessary if no Homestead Deductlon is
being filed.) `
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Signamre o/Buyer Signamre o/Buyerd/Spouse
C'hadPCf� Pfnhl Jr /� I3� I�S
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o/Sotial5ecunry Number Las[ 5 digi[s oJBuyer?/SpouseOriver's Stu[e Las[ i DtgiCS o�Social Security
Lirense/1D/0[herA'um6er Number Lirense/ID/O[herNum6er
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