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Homestead_Thompson
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 ---DP,REFA R ER �.. :". _ 7,": .v_t r. ' z -� -- J. David Roellgen Attorney Preparer of the Sales Disclosure Form Tide 801 Busseron Street Kolb Roellgen&Kirchoff LLP Address(Number and Street) Company Vincennes, IN 47591 (812)882-2280 roellgen(o emisonlaw.com City,State,and ZIP Code Telephone Number E-mail ?E:.SEL'L`ER(S)/GR'ANTOR(S); _ f Cri r Jane F Hartzburge Dem Ten of Isabel S Hyneman Estate Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 2635 S Sievers Road 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 complete as r-quired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". Strir Sign• ure of Seller • • C�9��S�o'l0�'� Signature of Seller J -- Hartzburge personal representative Printed Name of Seller Sian Date(MM/DO/YYYY) Printed Name of Seller Sian Date(M.M/DD/YYM F::BUYER(S)%GRANTEE(S)0:1:PLICATIONFORPROPERTYLTAX1DEDUGTIONSI TDENTIF,Y,'ACL' ITEMSTHATAP.PLY{ _-- Marion A.Thompson Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document 12030 S.Smithville Road Address(Number and Street) Address(Number and Street) Decker, IN 47524 THE SALES NO CONDITION DISCLOSURE MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIF CONDITION OF THOSETH^ gej.Y. YES ❑ 1.Will this property be the buyer's primary Q ❑ 3.Homestead F to' residence? Provide complete address of primary ❑ © 4.Slp En;/ Heating/Coonng System residence,including county: Sg ❑ gi 5.Wind�fl4 113 E First Street 4); Address(Number and Street) ❑ Q 6.Hydroelectric-P a)aqq'./t'''-vice Hazleton, IN 47640 Gibson ❑ 0 7.Geothermal Energy HLr2Cooling Device City State ZIP Code County (7] ❑ 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. 12030 S. Smithville Road Not available in all counties) Address(Number and Street) Decker, IN 47524 Knox Z & OP -o7 9- Q00 00609 3 0/9 City,State ZIP Code County Primary property owner contact name E-mail