Homestead_Michel INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER` ,. ..w :`:. . , . ". jt 4'; { `; , 1, . ;; . „s.£ - Th.. ._ I.s
KAREN HARBISON VP
Prepare,-of the Sales Disclosure Fenn Title
803 E STATE RD 68 HAUBSTADT STATE BANK
Address(Number and Street)
E-mail
-E;SELLER(S)%GRANTOR(S)s=. .'. ,,.'a...-'-;:._. ' . _ 1+' 7 ". ,•- __,. '. ., i<< :c.. ..4 • , ,i i
Cl INT,ICAMPBELL MFGAN M CAMPRFI L
Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
2990 W SR 68 2990 W SR 68
Address(Number and Street) Address(Number and Street)
HAUBSTADT IN 47639 HAUBSTADT IN 47639
City,State,and ZIP Code
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 c 1 tells required by law,and is prepared in accordance wiitth�IC`6-1,1-5,5,"Real Property Sales Disclosure Act".
'/�s// �le Il l ,I ' X l� VlJl d DM IM l� Lvti�4,�(, (�
S" azure of Senn: Signatu o eller
CI INT J CAMPRFI I 08/07/2019 MEGAN M CAMPBELL 08/07/2019
Printed Name o/Seller Sian Date(MM/aam'n) Printed Name of Seller ' I n fM a/rrn)
F:BUYER S GRANTEE(S),'=APPLICATION+FOR PROPERTY TAX•DEDUCTIONSIDENTIFYALL ITEMS lAjA PLy , : ::- -ems
CHOLAS W MICHEL ANDREA J MICHEL
• - yance document Buyer 2-Name as appears on conveyance documentAFi uG 0- 9 2019
2801 W SOYBEAN LANE 2801 W SOYBEAN LANE
Address(Number and Street) Address(Number and Street)
FT BRANCH IN 47648 FT BRANCH IN 47648
City,State,and ZIP Code City,State,and ZIP Code GIBSON COUNTY AUDITOR
E-mail Telephone Number E-mail
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 rnarvrl N
o 0 1.Will this property be the buyer's primary El ❑ 3.Homestea
,} residence? Provide complete address of primary El El4.Solar Energy Heating/Cooling System
residence,including county:
2990 W SR 68 El ❑✓ 5.Wind Power Device
Address(Number and Street) ❑ 6. Hydroelectric Power Device
HAUBSTADT IN 47639 GIBSON 0 0 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ 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 El 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.
2801 W SOYBEAN LANE Not available in all counties.)
Address(Number and Street)
FT BRANCH, IN 47648 GIBSON 014 -A2 -03 - /oo -o0o, aa! - oaY
City,State ZIP Code County
Primary property owner contact name E-mail