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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
j`D1PREPARERria _ z ._ P0,2 __
Deena Hendrickson Closing Services
Preparer of the Sales Disclosure Form Tide
7820 Eagle Crest Blvd Ste 201 Regional Title Services
Address(Number and Street) Company
Evansville, IN 47715 (812)759-5555 closines(Y)reeionaltitlellcom
City,State,and ZIP Code Telephone Number E-mail
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Barbara A.Ziliak
Seller I-Name as appears on conveyance document Seller l-Name as op.. rs on conveyance document
5311E11505 5311E119
Address(Number and Street) Address(N ber and Street)
Haubstadt, IN 47639 Haut: adt, IN 47639
Telephone Number E-mail
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".
_ Ll ?j t u d. �
rIgnatureojsdi r Signature of Seller
arbara:A?.ZiliakJ /J`2//zo/g
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/Yrvn
10IBUMER(Sil'fGRANIFEEfSI AP.REICATIONdEORiRROBERTTiYaTtAX9DEDUCTIONS_IDENTIE,WAHLIIITEMS1aTHAVAR IWP' =..u'--, S-%11;a17t ^I
Rodney D. Whitehead
Buyer I-Name as appears on conveyance document Buyer 2-Name as a rs on conveyance document
10447 E State Road 56 10447 E S e Road 56
Address(Number IN 47and 564 Address(Nu 475tr4t)
Orwell,IN 47564 Onv . IN 47564
THIS PROPERTY. IDENTIFY ALL OF THOSE THAT AP Y. ,
YESA NO CONDITION YTS N^- CONDITION k4
(�✓ 1.Will this property be the buyer's primary J 3.Homestead GIBBON COU t Y AUUI I urn
�+ residence? Provide complete address of primary ❑ p 4.Solar Energy Heating/Cooling System
residence,including county: ❑ p S.Wind Power Device
5311E 1150 S
Address(Number and Street) ❑ IZI 6. Hydroelectric Power Device
Haubstadt, IN 47639 Gibson ❑ El /7.Geothermal Energy Heating/Cooling Device
City,Smte P Code County ❑ emu{ 8.Is this property a residential rental property?
I 2.Does the buyer have a homestead in Indiana to be
❑ El 9.Would you like to receive tax statements for this
vacated for this residence? If yes,provide
complete address of residence being vacated, property via e-mail?(Provide contact information
ncluding county: below.Please see instructions for more information.
Not available in all counties.)
Address(Number and Street) Rodney D. Whitehead a�p—a31a-40a-� i. at(
City,State ZIP Code County Primary property owner contact name� E-mail
Number License/ID/Other Number