Homestead_Bene INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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USA THOMPSON MGR
Preparr of the Sales Disclosure Pam Title . -
1015 Third Street,Suite B First American Tide Insurance Company
Address(Number and Street) Company
Columbus,IN 47201 (812)314-7726
Gty,State,and ZIP Code Telephone Number E-mail
MCSELLER(S)7GRAMfOR(Slatt WS:Fa#lgra`s.�"F-..=' F:�w�e .air a :-=:a Til-X.2. .-XEISI MI< ;III-? :n2Wi.r 4`) i
Jordan C.Hicks Jordyn K.Hicks
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
1/7 5 l4es1 5-f 117 S War Sl-
Ad��der//ss(Number e Street) 7 �Q Address(Number and Street)
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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 required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". \\
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Signature orSe& Set [Lire Disc)/
• Jordan C.Hicks June 15,2018 Jordyn K.Hicks
Printed Name a'Seller Sign Date(MIVDD/YYYY) Printed Name a'Seller .r-„wait very
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{4)(GBP.Td7\E` )YHAP-PLIFAT.iON.F,OR PROP.ERTY�I TAX.DEDUCTIONS..:aIDENTfFI'fALLhITEM5H7NAT.RMPL)1J �.„h �_-�.
Monika Bete J Magdalena Sabo n
1-7n-7n as appears al conveyance document Buyer 2-Name as appears on car✓eya
l�
505 S Uncoin St 505 S Lincoln St
Address(Number and Street) Address(Number and Street)
Fort Branch,IN 47648 Fort Branch,IN 47648 •
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY.
Y1E,S. NO CONDITION YES NO CONDITION
y/�
x I ( l 1.Will this property be the buyer's primary
ss IX 1 3. Homestead
7� residence?Provide complete addre of I i
primary residence,including county: _' C&I 4. Solar Energy Heating/Cooling System
6 U.S S. 1-Z nc,0 1 P Ai-. I X1 5. Wind Power Device
Address(Numberr and Street)( l V 1 I I 6. Hydroelectric Power Device
i J irk r/r �S I N 47(p 41 ( :La...,LA.-- I ,] 7.Geothermal Energy Heating/Cooling Device
ay,State,�ZI-aP Code County 1 [�1 B. Is this property a residential rental property?
❑ 7"' 2. Does the buyer have a homestead In Indiana [g 9.Would you like to receive tax statements for
to be vacated for this residence?If yes, this property via e-mail?(Provide contact •
provide complete address of residence being information below. Please see Instructions for
vacated,including county: more Information. Not available in all counties.)
Address(Numbr and Street) a6_A(I_{Q _1O( _01, 0Gtb L1 p26
City,State ZIP Code County Primary _lproprty\owner contaa name V l ' E-mail
JUL 162018
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GIBSON COUNTY AUDITOR