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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D:PREPARER'- 1 .. ,r-_ _ ••- -— r --- c7:7577117 ---
Karen S.Creek Closing Agent
Preparer of the Sales Disclosure Form Tide
501 Main Street, Suite 101 Bosse Title Company
Address(Number and Street) Company
Evansville,IN 47708 812-421-4000 closinq.dept @ieffbosse.com
City,State,and ZIP Code Telephone Number
E-mail
E.SEI:CER(S)/GRANTOR(S) . ____
Anthony J Keil I on Keil
Seller 1-Name as appears an conveyance document Seller 2-Name as appears on conveyance document
C 10395 Hwy 57 I- 1o3?3 tiw7 5 7
Address(Number and Stree) Address(Number and treet)
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and cam t tete as(equired by law,and is prepared in accordance wi h IC 6-1.1- ,$,"Re Property Sales Disclosure Act".
Signaller Signature of Seller
APthony J Keil . °y/.2 g/at0/7 I on Keil •
Oil-24-TA1l
Printed Name of Seller Sian Date(MM/DDMT1) Printed Name of Seller Sian Date(M.e/DOM+Ii
F: BUYER(51/GRANTEE(S) AP,PL'ICATION]EOR,PROPERTY,TAXDEDUCTIONS=_IDENTIFYcAhhITEMSITHATAP,PLY. 2. ___ ___
Jay Viehe
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
1415 E.950 South
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 PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. Ot/ 2p��
YES NO CONDITION YES NO CONDITION
12 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.HomesteadG/Bs " '' it �,
residence? Provide complete address of primary ❑ Q 4.Solar Energy HeatingC/I9 ' 1e em
residence,including county: ❑ 0 5.Wind Power Device VO/rOR
1415 E.950 South
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Haubstadt. IN 47639 Gibson ❑ Fl 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ 12 2.Does the buyer have a homestead in Indiana to be ❑ 0 8. Is this property a residential rental property?
vacated for this residence? Ilyes,provide ❑ 14 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)
Z10-19 - 3Q -ate a5C) 3 S 5 a a 9
' City,State ZIP Code County
Primary property owner contact name E-mail