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Homestead_Hommrich INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D.PREPARER' . . . . Bryceann Cutsinger Preparer of the Sales Disclosure Form Title 226 W. Broadway Broadway Title, Inc. Address(Number and Street) Company Princeton, IN 47670 812-386-1687 bryceann.bti(amw.twcbc.com City,State,and ZIP Code Telephone Number E-mail E.SELLER(S)/GRANTOR(S) - . . Adam W Schmitt Seller 1-Name us appears on conveyance document Seller 2-Nome us appears on conveyance document 102 S Vnnna l n Address(Number and Street) Address(Number and Street) Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct ant to mpletglas r q ' ed by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". // 47/t lJy Signature of Seller 7- //-17 Signature of Seller Adam W Schmitt (/ Printed Name of Seller Sion DateIMM/DD//Yi'Y) Printed Name of Seller 1"1 A 17 Sian Date(M,M/DD/YYYYI F. BUYERS)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS- IDENTIFY ALL IluEtttvi A PPLY. - Patrick Hommrich Connie Hommrich • _ Buyer)-Name us appears on conveyance document Buyer 2-Name as appears on cony •L'9.Twerrlh • 117 Damosa Dr. 117 Damosa Dr. GIBBON COUNTY AUDITOR Address(Number and Street) Address(Number and Street) Haubstadt, IN 47639 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 d YES NO CONDITION ❑ 1.Will this property be the buyer's primary ❑ 3. Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence In jludingcounty: 1tl//JJ�� �N ❑ig 5.Wind Power Device Adddrress(Numbvm�erandStreet) ❑ El 6. Hydroelectric Power Device Haubstadt, IN 47639 Gibson ❑ 17 7.Geothermal Energy Heating/Cooling Device Z, ZIP Code County ❑ 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 ,.L„n^cluding count below. Please see instructions for more information. I I 7 bi4-ri o S.A ,b Q Not available in all counties) ., r ss Number and Street) t .,.v► to a •,.1 go-I 8 3&-'-f03 Q 4 3S9-ar9 City,State ZIP Cade County Primary property owner contact name E-mail