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Homestead_Rexing (20)
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 _-� rD:.P,REP:ARER . . q � '-f 4 ?j -'r,T ° _-a s 3 d. _ `mss 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 812-768-5800 kharbison(ahesbanc.com City,State.and ZIP Code Telephone Number E-mail "::'41 - -,tL •-= -*:�-"' .rdT `^y �S 1.--r.'a' '-e x�c _ —'.'J"-1 ,I?::SE�LEI2{$)%GRANTOR(S) - -. ._ �._, - � . F1 AINE R RFXING BRIAN L SCHMITT Seller I-Name as appears on conveyance document Seller 1.Name as appears on conveyance document 12509 S 50 E 20101 01 D PRINCETON RD Address(Number and Street) Address(Number and Street) HAURSTADT IN 47639 HAUBSTADT IN 47639 Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct a .t complete as required by jaw,and is prepared in accordance with I 6-1.1-5.5,"Real • op' y .:,- Disclosure Act". /Lit-_ •r✓a.• • /.- wear .S Signature of Seller "tore of Seller FI AINF R RFXING 04/15/2016 BRIAN TOL SCHMITT 04/15/2016 Printed Name of Seller . Sian Date(MM/oo/Yrrq Printed Name ofSeller Sian Date FMM/DO/YYYY) �(FsBUYER(S)/GRANTEE(S) APP,CICATIONtF,ORP,R0IERTPTAX+DEDUCTIONS 1DEN?TIF7(-AILrITEMSITHATeAP,P,L''Y, r ry- - LEE 0 REXING - CHELSEA N REXING Buyer I-Name as appears on conveyance document Buyer 1-Name as appears on conveyance document 269 Address W 1200 S 269 re 1200 um e S Address(Xumberand Street) Address(Number and Street) HAUBSTADT IN 47639 HAUBSTADT IN 47639 4p ITHE YES SALES DISCLOSURE M MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PERSOPER O IDENTIFY OADITION F THOSE THAT APP !N L00 NT ,v ❑ 1 Will this property be Provide complete buyer's primary s of primary ❑ 3.Homestead A(/O/TOR P P ry ❑ © 4.Solar Energy Heating/Cooling System residence,including county: ❑ 12517 S 40 W 5.Wind Power Device Address(Number and Street) ❑ 0 6.Hydroelectric Power Device HAUBSTADT IN 47639 GIBSON ❑ 0 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County Q ❑ 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 ❑ 17 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. 269 W 1200 S Not available in all counties.) Address(Number and Street) ry C/ �( HAUBSTADT IN 47639 GIBSON 2%o-z3-j 8 - 35p C� j _5, -o a 1 City,State ZIPCade County Primary property owner contact name E-mail