Homestead_Wright Jr _i
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
,TM w
SDXEREFARER w'et. -.�:� . --....,_Cty: ai� '^%7'^-`+h-syc�"'Trx°'��-p�"�'t° ^ _—sv :rA7"4 t;ee??` ,,;,t a'r,'c"—s s
KAREN HARBISON VP
Preparer of the Sales Disclosure Form Title
803 E STATE RD 68 HAUBSTADT STATE BANK
Address(Number and Street) Company
HAUBSTADT IN 47639 812-768-5800 kharbison(o)cimail.com
City,State and ZIP Code Telephone Number E-mail
dSELliER(S)`/.GRANTORRIS)t.... -rte `5.-'+�.i�`;5 01./ecr: .if.kt a j7 aTr--s 5s-srt!3,310,---ryt.T'--71-Tek, { -.757
�..-�.�.c.l" ril yr-eitbt cti.ne 1a. Y�n'�
PATRICK A KIERNAN PAMFI A M KIFRNAN
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
5103 5 775 W 5103 S 775 W
Address(Number and Street) Address(Number and Street)
OWENSVII IF IN 47665 OWENSVII I F IN 47665
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
antjr mplete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller • Signature of Seller C'-
PATRICK A KIFRNAN 11/1472016 PAMELA M KIERNAN 11/3,i/2016
Printed Name of Seller Sian Date(MM/OD/Yrret Printed Name of Seller Sian Date(MM/00/YYY11
FFBUYER(S)%GRANTEE(S)°AP,P.LIGATION`FOR):PROPERITITAX DEDUCTIONSBDENTIFYTAtiIMEIC SiTHATKPPPLY% ° --='M
DONALD J WRIGHT JR JILL M WRIGHT
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance doe . t' 0.
7685 Address W 2m5 r 7685 W 275 S -t
Address(Number and Street) Address(Number and Street) ''"YC �,l
OWENSVILLE IN 47665 OWENSVILLE IN 47665 Al/
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF TIIOSIirud •
YES NO CONDITION YES NO CONDITION O/^/T
0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead ,'9(7�/TT
residence? Provide complete address of primary ❑ 0 4.Solar Energy Heating/Cooling S}e$m
residence,including county:
5103 S 775 W ❑ FI 5.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
OWENSVILLE, IN 47665 GIBSON ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
0 ❑ 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.
7685 W 275 S Not available in all counties.)
Address(Number and Street)
OWENSVILLE IN 47665 GIBSON 210 -17- 0 a -'-ico 01 y i5 a 9- 0Q'
City,State ZIP Code County
Primary property owner contact name E-mail