Homestead_Higginson •INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER
_ KAREN HARBISON VP
Preparer of the Sales Disclosure Form Title
803E STATE HWY 68 HAUBSTADT STATE BANK
Address(Number and Street) Company
HAUBSTADT IN 47639 812-768-5800
City,State,and ZIP Code Telephone Number E-mail
E.SELLER(S)/GRANTOR(S) _ _- _.
CHAR! FS A REYNOLDS CARO! K RFYNOI DS
Seller I'Name as appears on conveyance document Seller 2-Name as appears on conveyance document
12814 S SUNSET DR 12814 S SUNSET DR
Address(Number and Street) Address(Number and Street)
Under penalties of perjury,1 hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
. and cs required aw,and is epared in accordance with IC -1.1-5.5,"Real Property Sales Disclosure Act".
!Signature of Seller 1 Signature of Seller
CHAR! ES A RFYNOI DS /-2_2 2 CAROL K REYNOI DS q-aa - I
Printed Name ofSeller Sian Date(MM/OD Printed Name of Seller S n are ire/YYY}1
F.BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-'IDENTIFY ALL ITEFTI�I 7
•
N C HIGGINSO RACHELLE L HIGGINSON JJ��
C Buyers-eume us appews on conveyance document Buyer 2-Name as appears on conveyance docus5JCf e p 2 5 201/
12245 S BROOKE DR 12245 S BROOKE DR
Address(Number and Street) Address(Number and Street)
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION ES NO CONDIT(
0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary -" 0-7 4.Solar Energy Heating/Cooling System
residence,including county: ❑
12814 S SUNSET DRIVE S.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
HAUBSTADT IN 47639 GIBSON ❑ 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
0 ❑ 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 ❑ 1z1 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.
12245 S BROOKE DRIVE Not available in all counties.)
Address(Number and Street) )
HAUBSTADT IN 47639 GIBSON .t.4- A of -/y-J 00 - DO/, 7/ 7 -0 a y
Ciry•,State ZIP Code County
Primary property owner contact name E-mail