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Homestead_DOrworth
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D:PR_,A—E-R --- - -- - - - -— 27r, I ,_. - r]t'f:--•-� - - R -T� t_ _�_.�-• "'rs Roman Ricker Attorney Preparer of the Sales Disclosure Form Title 219 N. Hart St., P.O. Box 13 Partenheimer. Kinkle&Ricker Address(Number and Street) Company Princeton. IN 47670 E-mail SELLER(S)%GRAN,TOR(S)_:c _Y . tv,.'_U. _ .a� _—._-,1 .i _r....'C; Frica Shea Rummel Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 1006 N Jackson Address(Number and Street) Address(Number and Street) . Huntingburg IN 47542 E-mail 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 rs plete as required NV,and is prepare in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". LA Vic— 11\i Signature of Seger Signature of Seller Frica Shea Rummel 4/17/2019 Printed Nome of Seller Sian Date(MM/D0/11711 Printed Name of Seller Sian Date(M.M/DD/YYYI) ,'F.BUYER(S)'/.GRANTEE(S) APPLIGATION/POIPROPERTY;TAX.DEDUC-TIONS?__IDENTIF}%ALL.ITEMS.THAT i1PPL'Ys.•47± Derek A. Dorworth Abbvo Wolfe �t--�gqyFLED Buyer Name as appears on conveyance document Buyer 2-Name me as appears on conveyance duty 705 W. School Street - 705 W.School Street Address(Number and Street) Address(Number and Street) Francisco, IN 47649 Francisco. IN 47649 APR 2 2 2019 - �) -mail THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPL GIBSON COUNTY AUDITOR YES NO CONDITION I YES NO CONDITION 0 ❑ 1.Will this property be the buyer's primary ❑ 3.Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: 318 W First Street ❑ ❑✓ 5.Wind Power Device Address(Number and Street) ❑ 2 6.Hydroelectric Power Device Oakland City, IN 47660 Gibson - ❑ Q 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ El 2.Does the buyer have a homestead in Indiana to be El ❑✓ 8 Is this property a residential rental property? vacated for this residence? If yes,provide ❑ 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) a6-P-Hg-/au- Dp! /58-00/-� r Derek A.Dorworth&Abbygaylle M.Wolfe l/ City,State ZIP Code County Primary property owner contact name E-mail Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct