Homestead_Ziliak (11) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
•D-M REPARER, . --- -
Brvceann Cutsinger
Preparer of the Sales Disclosure Form Title
226 W. Broadway Broadway Title, Inc.
Address(Number and Street) Company
Princeton, IN 476700 812-386-1687 samantha.btiemw.twcbc.com
Ciry,State,and ZIP Code Telephone Number E-mail
Frir Campbell Krystal D Campbell
Seller I-Name as appears on conveyance document Seller 2-Name as appears an conveyance document
400 W FIm St 400 W FIm St
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 co plete •ss re u• ed by law,and is prepared in accordance wit t I 6-1.1-5.5 "Real • operty Sales D. closure Act".
ig of Seller Signora• of Seller /�j�
Eric Campbell G,- q - KO Krvstal D.Campbell 17-9- ! `i'
Printed Name of Seller Sian Date(MM/DO/m9) Printed Name of Seller Sian Date(MM/DD/raY)
-
DEDUCTIONS FOR TiIIS PROPERTY. IDENTIFY ALL OF THOSE THQ7aPPLY: We
YES NO CONDITION � YES NO COND r ' SON - -1,--•0 ❑ 1.Will this property be the buyer's primary 0 ■ 3.Homestead �UHTy 1".•
residence? Provide complete address of primary �__is o ar Energy Heating/Cooling Syste i O)TO
residence,including county: ❑ 5.Wind t.nd Power Device
R
400 W FIm St
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Haubstadt, IN 47639 Gibson ❑ vi 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
IZEl 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 ❑ 0 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.
8848 S-100 W. Not available in all counties.)
Address(Number and Street)
Ft. Branch, IN 47648 Gibson 016.'i9 J/_ 303_ I° , QO_03 y
City;State ZIP Code County
Primary property owner contact name E-mail