Homestead_Rumble INDIANA SALES DISCLOSURE FORM SDF ID: 2017 Page 2
D. PREPARER
Rocksan Underhill Escrow Officer
Preparer of the Sales Disclosure Form Title
605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
Address(Number and Street) Company
Evansville, Indiana 47713 (812)425-0055 rocksan @swinland.com
City, State, and ZIP Code Telephone Number E-mail
E. SELLER(S)/GRANTOR(S)
Larry D. Beatty Diana S. Beatty
Seller 7 -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
108 S Campbell Blvd 108 S Campbell Blvd
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 complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
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ignatur o I er r S Signature of Seller
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Larry D tty � -(� )" I� Diana S. Beatty 3��,J 1'
Printed Name of Seller Sign Date(MM/DD/YY Y) Printed Name of Seller Sign Date(MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
David J. Rumble Tess L. Rumble
Buyer 7-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
9867 W 100 S 9867 W 100 5
Address(Number and Street) Address(Number and Street)
Cynthiana, IN 47612 Cynthiana, IN 47612
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF 4f@SE THAT A
YES NO CONDITION \YrES NO CONDITION �f s
X, ❑ 1. Will this property be the buyers primary /f ❑ 3. Homestea&'.&e ,t,� •
�Oi,,
residence? Provide complete address of primary p �/ 4. Solar Energy Heal .r - ?ii 4 S tern
residence, including county: /V 7j•.;
❑ 5. Wind Power Device V7>
108 S Campbell Blvd. qU
Address(Number and Street) ❑ 6. Hydroelectric Power Device OiTO
Haubstadt, IN 47639 Gibson ❑ A 7. Geothermal Energy Heating/Cooling Device
City, State ZIP Code County ❑ 8. Is this property a residential rental property?
❑ 2. Does the buyer have a homestead in Indiana to be
❑ -9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete property via-email? (Provide contact information
address of residence being vacated, including county: below. Please see instructions for more information.
CA g 6, 7 W /0 00 S Not available in all counties.)
Address(Number and Street)
Gyn-Ri,,,,, �N 91c; I2 Qkr/ - 310-yo3c�dd�8'5cb9
City rate ZIP Code County
Primary property owner contact name E- ail