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Homestead_Adler INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 !D.P,REPAR$R . 4,74.Cn ..�aS� sq.tbe eza-%::c:1:.3* � _..:s'W;;;'*;. .=fix+t: ,nW' :riln KAREN HARBISON VP Preparer of the Sales Disclosure Form Tide 803 E STATE RD 68 HAUBSTADT STATE BANK Address(Number and Street) Company HAUBSTADT IN 47639 812-768-5800 kharbison(Wesbanc.com City,State,and ZIP Code Telephone Number E-mail EE>SEIiLER S 'GRANTER S Y �,..-fa r7. .S � . .;'q Y f r r m z s _ ( �/ ( � � 1_.L�'��:::'�f'ata� 1 ' SrY "x^3�y � {.'���:'��•N^S�T�j-�F.`�k`�.f PHYLLIS R BECK Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 8743 E 200 S 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 and corn! • e as r-quir d by law,and is repared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". rof i a-• - .. Signature ' /jsar Signature of Seller PHYLI IS R :ECK s7(? Jr / z27 Printed NamtofSeller r'4n eat MM n n d o Seller of Sign Date(MM/D0/YY)11 i,E1•8UYER(S)%GRANTEE(S)TAPPLIEATION!Ei''P.ROPERTiYs,TAXtDEDUGTtONS`'IDENTIEYFi1 LC;ITEMSiTHAT;rAP,PLYrk; ` CTiYa ' DEAN A ADLER SHERRI L m ADLER Y LED D Buyer Name as appears on conveyance Buyer �Name Name appears on conveyance dx t 7096 S DIVISION ST 7096 S DIVISION ST 4 Address(Number and Street) Address(Number and Street) OAKLAND CITY IN 47660 THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE Ei 'COUNTY AUDITOR YES NO CONDITION YES NO CONDITION ❑ 1.Will this property be the buyer's primary 171 ❑ 3.Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: ❑ 12033 E HICKORY LANE 5.Wind Power Device Address(Number and Street) ❑ 0 6.Hydroelectric Power Device OAKLAND CITY, IN 47660 GIBSON ❑ 0 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ 2 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 ❑ 2 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) /'/�'�/ G City State ZIP Code County - — -/c? �)� Coo 1 053-00(6 Primary property owner contact name E-mail