Homestead_Culbertson INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
Leon C. Stone President
Preparer of the Sales Disclosure Form Title
226 West Broadway Street Broadway Title, Inc.
Address(Number and Street) Company
Princeton, IN 47670 (812)386-1687
City,State and ZIP Code Telephone Number E-mail
SEIMER(SVGRANTOR(Si'i.„.;.; il;;Fi.g714:"§"!-.3":
Tristan I I eyeless
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1161 North State Road 57
Address(Number and Street) Address(Number and Street)
Oakland City IN 47660
Under penalties of perjury,thereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and tcomplete as requir d 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
Tristan I I oveless 2 /C - / 7
Printed Name of Seller Sian Date D01/DDIVYVY] Printed Name of Seller Sign Date(MIWIWITYY]
.F.,BUYER(SI/G RAW TEE(Sy2L'5APPLICAPION FORTROPERTY/TAX DEMI CTI ONS;`4DENTIEY ALIATENISTHATTAP.PLY221,71 -72-7
Flint G.Culbertson
Buyer! Name as appears on conveyance document Buyer 2 Name as appears on conveyance document
214 First Avenue
Address(Number and Street) Address(Number and Street)
Oakland City, IN 47660
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF TB E TH A '
YES NO CONDITION I YES NO CONDITION
E 1.Will this property be the buyer's primary vj ID 3. Homestead FEB 17 2017
residence? Provide complete address of primary g 4.Solar Energy Heating/Cooling S stem
residence,including tg county:
5.Wind Power ' —4 —•/
1161 North State Road 57 ' vsmitt.
Address(Number and Street) E 6.Hydroelctsths 01:513 • tY AUDITOR
Oakland City, IN 47660 Gibson 5 E 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
D IS 8. Is this property a residential rental property?
2.Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide 9 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.
Not available in all counties.)
Address(Number and Street)
City,State ZIP Code County - ) -D 0- 9-c-00
Primary property owner contact name E-mail