Homestead_Siekman (8) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2•D?P,•REPARR
Jillian Haase Closer
Preparer of the Soles Disclosure Form Title
. 606 Main St. Dubois County Title
Address(Number and Street) Company
Jasper, IN 47546 812-482-1696 _
City.State,and ZIP Code Telephone Number E-mail
•
ljE_SELtER(SI/.GRANROR(S)� — ' -- -
-I
Gwendlyn Siekman
Seller I-Name as appears on conveyance document/ ' Seller 2-Name as appears on conveyance document
7
! ' 7 5 4 OCe4t' e _
Address(Number and Strpeet) 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 co plete as required by law, . d is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
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Signature ofil ,- - Signature of Seller
. -I. ii. ' .1-. 0 /19/ 018
Printed Name of Seller Sian Date(MM/DD/YYYY) Printed Name of Seller Sian Dote(MM/DD/YYYY)
;F BUAY ER MXGRAN?liEE(S)t-l+APP.MATIOgzrO 41P,RO P E RTtY,TArDEDUGTIONSiIDE NIMFY;ALL';ITFMSiT1HATV,PtL'1'a
Tyler Siekman t��q1--'�,,yy'' q�\@
Buyer l-Name as appears on conveyance document Buyer 2-Name ascope: rt�'on�tT�c e t 11 H •
8437 E 900 S $$ 111111!!!!!! JL�'
Address(Number and Street) Address(Number and Street)
Buckskin, IN 47647 FEB 2 6 2018
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THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFN EMPBOSETHAT APPLY.
YES NO CONDITION • YES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary ( ❑ 3. Homestead
residence? Provide complete address of primary ❑ Er 4.Solar Energy Heating/Cooling System
residence,including county:
❑ 2' 5.Wind Power Device
Same as Above
Address(Number and Street) ❑ 1[ 6.Hydroelectric Power Device
Gibson ❑ Geothermal Energy Heating/Cooling Device
City StateZ 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 ❑ 171 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)
a i,— a a- a g -.1 a o-6o0.9sa -6o1
City,State ZIP Code County
Primary property owner contact name E-mall