HomeMy WebLinkAboutHomestead_Hart (2) INDIANA SALES DISCLOSURE FORM SDF ID: . Page 2
.D P,REPARER• _ - - -
STACY C TEVAULT MORTGAGE LOAN SPECIALIST
Preparer of the Sales Disclosure Form Title
910 W MAIN STREET LNB COMMUNITY BANK .
Address(Number and Street) Cortopany '
BOONVILLE, IN 47601 812-897-4700 STEVAULT(a)LNBCORP.COM
City,State and ZIP Code Telephone Number E-mail
E:SELUER(S)%CRANTO.R(-S)'- - - - -
— -- — — �—
DAN L CI ODFFLTFR KATHY M CLODFFI-TER
Seller I-Name as appears on • 'once document Seller -Name as appears on conveyance document
pm Or /1e1 A t•` IIfi-e-�
A dress(Number and St net) n �/ l,, / A'dress Humber and Street) ` 2,�
A 144 Rad7 r0..s Rte+' /!/ea/h/ h P) Rrd Biu 4& 7 eoLui CAI 51-2( *o
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and potnplete s equired by law,and is prepared in accordance with C 6-1.1:5.5,"Real Property Sales Disclosure Act".
(�/iJ( t
Signature of5eh r / S' nature o Iler I
PAN I fl OFIFFI TFR `5//70 / 7 •s • U •.
Printed Name of Seller Sian Dat (MM/DD/YYY)t ,Printed Name of Seller Sian Date(MM/DD/YYYi)
_F.BUYER S)%GRANTEE(S).=APPLICATION;FOR'PROPERTY_TAX-DEDUCTIONS=(DENTIFY.ALL ITEM P _
RYAN S HART '. BROOKE S HART !� I— .� .`
• ••• on conveyance document
eY Buyer 2-h'ameat appears on conveyance•I m '
-: ' T RD 68 2940 W ST RD 68
Address(Number and Street) Address(Number and Street) MAR 2 7 2017
HAUBSTADT, IN 47639
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary ( 10— ❑ 3. Homestead
residence? Provide complete address of primary —0-177-1.Solar tnergy eating/Cooling System
residence, including county: ❑
4066E 950 S 5.Wind Power Device
Address(Number and Street) ❑ WI 6.Hydroelectric Power Device
HAUBSTADT IN 47639 GIBSON 7.Geothermal Energy Heating/
LI gy a Cooling Device
Ciry,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.
2940 W ST RD 68 Not available in all counties.) .
Address(Number and Street)
HAUBSTADT IN 47639 GIBSON aZ 6 ., / 9- ,j 4 _ 3oL' - boo , //b O Are
City,State ZIP Code County I
Primary property owner contact name E-mail