Homestead_Owen INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
Tiffany Hoon Closer
Preparer of the Sales Disclosure Form Tide
7820 Eagle Crest Blvd Ste 201 Regional Title Services
Address(Number and Street)
City,State,and ZIP Code Telephone Number E-mail
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Ellis Estates LLC
Seller l-Name as appears on conveyance document Seller 1-Name as appears on conveyance document
7199 Newman Rd.
Address(Number and Street) Address(Number and Street)
Elberfeld, IN 47613
srat{ana L(P Caae stare,ana LIP woe
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".
- l_
Signature of Seller n `'f� (� SignatureofSeller
Ellis Estates LLC 11-647/201/
Printed Name of Seller Sign Dote(MM/DD/YYM Printed Name of Seiler Sign Date(MM/DD/YYYY)
P DBUYER(S17/G TEE(S'IWIAPP.LICATI0N E0RIP.RAPERTiY>TAX+DEDUCTIONS;51DENT1FYIABE5ITEMSsTHATfAPELYsi
Levi Owen
• on conveyance document Buyer 2-Name as appears an conveyance document
-3It-Frrnvision St. F I T.RD
Address(Number and Street) Address(Number and Street)
Mount Carmel,IL 62863 Ma 17 2019
Number GIBSON COUNTY AUDITOR CBE-mall
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPER HAT APPLY.
YES NO CONDITION NO CONDITION
•
] ❑ 1.Will this property be the buyer's primary ❑ 3.Homestead
residence? Provide complete address of primary r ere Hea • poling System
residence,including county: ❑ 0 5.Wind Power Device
102 E Poplar Street
Address(Number and Street) ❑ 0 6. Hydroelectric Power Device
Owensville,IN 47665 Gibson 0 0 7.Geothermal Energy Heating/Cooling Device
City,smtrz code County ❑ rg 8. Is this property a residential rental property?
0 [I 2.Does the buyer have a homestead in Indiana to be 0 0 9.Would o • receive tax statements for this
vacated for this residence? If yes,provide
complete address of residence being vacated, operty via e-mail?(Pro ntact information
including county: below. Please see instructions farmo • ormation.
Not available in all counties.
•
26-17-01-404-000 . 043-D22
Address(Number and Street) evi Owen
City,State ZIP Cade County Primary proper ame E-mall
Number License/ID/Other Number