Homestead_Kiesel i •
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2•PDTP,REP,ARER4' -' i"ttl:1 `R` ,A'TYsSi°9- .sa&-71±1%21}7'S°'r;r„-?"t!. 'rtisSir :4allff.''°77.N }-, •y l.,;°:..c z'1
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 812-768-5800 kharbison(ahesbanc.com
City,State,and ZIP Code Telephone Number E-mail
sE SEERER(SI/•GRt1NTOR(S) z,. 'gtiEr "LE'.'°42,17,, vz,,T„t. T.-C3 .3 1'liS.r „ ''c•+c`'-"4 ''ae�k*-`Y ?
.IFTTA,I CI INAIFF __ _
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
904 ADAMS 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 complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
✓----"--7-
, ,i Signature of Seller
MI 1 LB a 11/21(2016
Printed Name of Seller • Sign Date(MM/DD/YYYY) Printed Name of Seller Sian Date(MM/DDRTYn
7,F:1-BUYER(S)/GRAN,TEE(S)trICRRLIGATION;FORTR OP.ERVATAXAiEDUCTIONS'-11DENTIFY}A ISITEMScTHATiAP,PLY=_ TWT
BENJAMIN A KIESEL
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance ''' '''"""111
Address W STATE RD 68 p /
Address(Number and Street) Address(Number and Street) �,
HAUBSTADT IN 47639
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS P•r• ' -'-I OF THO r f%
Y( v,Ppl►r
YES NO CONDITION s NO CONDITIO.'_ , a-
0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of prima • l!4 4.Solar Energy Heating/Cooling System
residence,including county:
1144 E TAFTOWN RD ❑ rA 5.Wind Power Device
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
PRINCETON, IN 47670 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.
Not available in all counties.)
Address(Number and Street)
C-�)^ (0 - I a�S' on _m u s'O-037
City,State ZIP Code County
Primary property owner contact name E-mail