Homestead_Seibert INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
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D�P.REPARfiR ' _ � .a' �i ' � � '+��'�` a'��`��."� ��= `r� _,�.�; `':
Timothy Shea Closing Services
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Ste 201 Regional Title Services
Address(Number and Street)
War ¢a 41 N "".�aa'GS S` '- . "t az=` a".-)-'-ti' i%r' t:.—:-'1,4 . +-s sj aa"vr a
Sara E. Elliott
Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document
Address�(Number and Street) Address(Number and Street)
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Y1- (ert..a.V `t t-t•11-P(4
Telephone Number E-mail
Under penalties of perjury,l,hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
mplete a,Sa equired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
`l'lp�{If.CA�, of
Signature of Seller Signature of Seller
Sara E Elli i, , ZQ/q
7fed Name of Seller Sig Date M.N/DD/YYY1] Printed Name of Seller Sign Date(MM/0o/YYYY)
•F313UYER(SWGR"ANUI EJS'PAPP.L'ICATIONiFOR1PROP.ERIEWAXiDEDUCTIONVIIDENTIFYPALL1TEMS=THAT=AP.BLYr ' — " .-0
Mark A. Seibert Abigail J.
Buyer l-Na rs on conveyance document Buyer 2-Name as appears on conveyance document
rem(Number and Lk, Acorns Num er an azet
CV" dre, c.t-. K) t-t'l 1.4 Cie it Lf-t-,GI. `S tJ c-1-14 L(
E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FORT OPERTY. IDENTIFY ALL 0 HBS•THAT APPLY. FILED
YES NO CONDITION YES NO CONDITION
ist ❑ 1.Will this property be the buyer's primary tRi. ❑ 3.Homestead Aug 13 2019
residence? Provide complete address of prir({gry 0 4-Solar Energy He ' /Cooli4fritegtr
residence,including county: 5.Wind Power Device GIBSON COUNTY AUDITOR CB
904 S Center St p
Address(Number and Street) El 0 6.HydroelectrlccPower Device
Fort Branch,IN 47648 Gibson ❑ 21 7.Geothermal Energy Heating/Cooling Device
City,Sate ZIP Code County ❑ 8.1s this property a residential rental property?
❑ ❑ 2.Does the buyer have a homestead in Indiana to be LI Q 9.Would you ' tom :e xstatements for this
vacated for this residence? If yes,provide pr y via e-mail?(Provide Co iract-information
complete address of residence being vacated, elow.Please see instructions for more information.
including county: Not available in all counties)
Address(Number and Street) 26-19-19-103-000 . 007-026
Mark A. eibert Abigail J. Hollis
City,State ZIP Code County Primary property own name -fall