Homestead_Crabtree INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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KAREN HARBISON - VP-__ _
Preparer of the Sales Disclosure Form Tide
803 E STATE HWY 68 HAUBSTADT STATE BANK
Address(Number and Street) Company
HAUBSTADT IN 47639 812-768-5800 kharbisoneesbanc.com
City,State,and ZIP Code Telephone Number E-mail•E.SELLER(S)'/GRANTOR(S)::I: , - ;. 4 .. c1"4-it ' f,:: +' - •E,'.' . ' ''•
CHARLES WAYNE I INDSEY J;WFNDOI YN MARIE I INDSEY
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
412 S BRAD/EY DR 412 S BRAD/ EY DR
Address(Number and Street) Address(Number and Street)
HAUBSTADT IN 47639 HAUBSTADT IN 47639
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and c m.�p.'l'.ete as required by law,and is prepared in accordance with IC 6-1,1-5.5,"Real Property Sales Disclosure is( lL/ Act".
Signature ofSeller �i Signature of� /r/i.vr-K/�)�L,Cr
CHARI ES WAYNE 1 INDSEY 03/06/2017 GWENDOLYN MARIE LINDSEY 0 /06/2017
Printed Name ofSeller Sign Date(MM/DD/YYYY) Printed Name of Seller t last MYYI
'F?BUYER S GRANTEE S =''• ' �.,.w:ii a E.r: 'n.!-' !TY TAX DEDUCTIONS IDENTIFYALL'1TEMS i.i- , ';LY:,-;a 0 2.",..•'.T
STEVEN R SEIB '•T 411Arb JA EIBERT
Buyer -Name as non c• nee*acumen Buyer 2-Name as app • on conveyance document,.
3926 W ST, E RD 68 3."701P 3926 W STAT `D 68 MAR 8 2017
Address(N •er and Street) Address(Numb- and Street)
FT B' •NCH IN 47648 FT B-: a IN 47.•: __/
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION !ES '50 rs\D TION
0 ❑ 1.Will this property be the buyer's primary C 0 ❑ 3. Homestead
residence? Provide complete address of primary ❑ 0 4. oar nergy Heating/Cooling System
residence,including county: ❑ ❑
412 S BRADI EY DR S.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
HAUBSTADT IN 47639 . GIBSON ❑ 0 7.Geothermal Energy Heating/Cooling Device
Ciry,State ZIP Code County
❑ 0 2.Does the buyer have a homestead in Indiana to be ❑ B.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)
A% . 23 -06 -/03 - coo . 6„ /)- 00y
City,State ZIP Code County
Primary property owner contact name E-mail