Homestead_Goedde INDIANA A EDISCLOSUREF R S L S FORM SDF ID: Page 2
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KAREN HARBISON VP
Preparer of the Sales Disclosure Form Tide
803 E STATE HWY 68 HAUBSTADT STATE BANK
Address(Number and Street) Company
HAUBSTADT IN 47639 812-768-5800 tharbisont)esbanc.com
City,State,and ZIP Code Telephone Number E-mail
CI At lDII IS E NIINEZ-SAI EMIF
Seller 1•Name,avppearsoncanp,7re document Seller?-Name as appears on conveyance document
l/d (Nlumby/nra.e[)</ _727��J// Sc?
Address(Number and Street)
lCA -4
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and co7p ete as quired bb'y^law and is preps d i ccordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
A.
777
ugnature of Seller Signature of Seller
11 AI11)II IS F NIINF7 SAI EMIF 10/31/201R
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name ofSeller Sign Date(MM/DD/YYYY)
F:BUYER(S)/GRANTEE(S) APPLICATION FOR PROPERTY-TAX DEDUCTIONS-IDENTIFY TT THg97AF L
KRISTINA M
Buyer 2-Name as appears on conveyance document
104 N HULL ST NCV 1 3 2°4°
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 YES NO CONDITION
Q ❑ 1.Will this property be the buyer's primary iv 0 3.Homestead
residence? Provide complete address of primary 0 4.Solar Energy Heating/Cooling System
residence,including county: ❑
104 N HULL ST 5.Wind Power Device
Address(Number and Street) 0 0 6.Hydroelectric Power Device
FT BRANCH, IN 47648 0 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 0 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.
Not available in all counties.)
Address(Number and Street)
t C- j 4-13- 304 -600.9/Mb
City,State ZIP Code County
Primary property owner contact name E-mail