Homestead_Hipp t
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER•:..>_= '. c. :=7 . , _ -- "�-
Christina Ferguson Closing Agent
Preparer of the Sala Disclosure Form Tide
501 Main St.Suite 101 Bosse Title Company
Address(Number and Street) Company
Evansville,IN 47708 812-421-4000
City,State,and ZIP Code Telephone Number E-mail
SE.SEl1:ER(S)/,GRANTOR(S) _ - _ - ___ a_^:1'._y _L- =A t. '•-ata .: . r— _Iff,._ " : ;72c `.�,
Donald R Blankenberger Jody M Blankenberger
Seller-I_Name e a pears on conveyance document .. l.,''� Seller 2•Name as appears on conveyance document
LAddd}.Vr-Ij-/M7nnibe rdd SLtreeet)) • /✓�sWD^gc— t !X) cAddfess-(Numbera
i!ct.v�514 l l e �N -�
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and .mplete`asr-quit-dbyla ,and'-. prepared in accordance with -1. -5.5,"Real P, o rty ales isclosure Act".
-.Sign`atureofSeller - = ;Signo[ of Sell
Ronald R Rlankenherger 08123/2016 Jody Blankenberger 08/730016
Printed Name of Seller Sian Date(M.M/OD/YYYYI Printed Name of Seller Sian Date(MM/DD/YYf)
.F:1311YERPT/GRAN (SKAPPLIGATION+F.OR•PROPERTY,:TAXDEDUCTIONS°1DENTIFYALD,ITEMS`THAT.t�f2j;Yy _.,�r
Jared S. Hie• -d6"r )r-.-
Buyer I Name• - pears on conveyance document Buyer 2-Name as appears on conveyance document /p�,,�
PO Box 28 f' t\.
Address(Number and Street) Address(Number and Street) 4/,^ — A' f
Haubstadt,IN 47639 U(y 29 9
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.Of�NJ y
YES NO CONDITION i__ye N- CONDI "1/jn,7
0 El 1.4Vill this property be the buyer's primary o ❑ 3.Homestead OR
residence? Provide complete address of prim. - �,_.il 0 4.Solo -• •eating/Cooling System
MI6,ce'fin ing county: ❑
5.Wind Power Device
�(N sera trn) 14„.1b 3i /-._/_c6,� ❑ Q 6.Hydroelectric Power Device
( �' ..Lti C7"ff� ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
TA ❑ 2.Does the buyer have a homestead in Indiana to be El 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.
112 S.Second Street Not available in all counties.)
Address(Number and Street)
Haubstadt, IN 47639 Gibson 23 -/q-J/-a/ _u sso°0A —099 -
City State ZIP Code County
Primary property owner contact name E-mail