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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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KAREN HARBISON VP
Preparer of the Sales Disclosure Form Title
803 E STATE HWY 68 HAUBSTADT STATE BANK
Address(Number and Street) Company
HAUBSTADT IN 47639 815-768-5800 kharbison(aesba nc.com
City State,and ZIP Code Telephone Number E-mail
...E..SELEEitiSI/GRA.NTOR(S)\__Ir._ i„,-1,, I 's."_‘•:.._.,-17::.- r-__.: %!a_-•- x*,• - • :-. -- Cr '•• . .'. -7.-e77-nE:77-.5'..5./: 'Tr]
MICHAEL L GALVIN VARBI J GALVIN
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
12726 S BROOK DRIVE 12726 S BROOK DRIVE
Address(Number and Sweet) Address(Number and Street)
Under penalties of perjury,I hereby certify that this Sales Disclosure,to th best of my knowle• :e and belief,is true,correct
and complet as ruijed by I w, nd is prepared in accordance vith1 yaS," I Pr,p L 7- ales Disclosure Act".
Seller li• •
st...?
1 ) LaY 71
..W
Signature of S y Signature of Seller
MICHAEL I GALVINE 06/11/7016 VARBI J GALVIN 06/11/2016
Printed Name of Seller Sian Dote OHAVDD/M11 Printed Name ofSeller Sian Date 1MWODIYMI
''F.PBU.YER(S)/GRANTEE(SIV,KPPLICATION;POR:KOPERTALC){7iDEDT1.01 . 1DENTIFEVITilaITEMSITT-1ArAF',BEY:. ,ff. '---:- •-''
ERIC S CAMPBELL KRYSTAL D CAMPBELL
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
_400 W ELM _ 400 W ELM --
Address(Number and Street) Address(Number and Street)
THE 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 JUN 16- 2016
E n 1.Will this property be the buyer's primary 0 111 3.Homestead
residence? Provide complete address of primary D gl 4.Solar Energy 1 ' • ystem
residence,including county:
Li GI 5.Wind PgISSOtteeDUNTY AUDITOR
12226 S BROOK DRIVP
Address(Number and Sweet) 9 0 6.Hydroelectric Power Device
HAUBSTADT IN 47639 GIBSON 9 E 7.Geothermal Energy Heating/Cooling Device
City State ZIP Code County
9 I7) 8.1s this property a residential rental property?
El D 2.Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes,provide D E 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.
400 W ELM ST Not available in all counties.)
Address(Number and Street)
HAUBSTADT IN 47639 c%- 3 -go- Ito -002.0195-a?v
City.State ZIP Code County
Primary property owner contact name E-mail