Homestead_Heldt (7) I
I INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
-D.PREPARER_' _ _ ''!r -Ui:re ,._c ` _ >Vi . .1-- Cir:•_1 .�Z._ *z;_ _ -Ltj
J. Robert Kinkle Attorney
Preparer of the Sales Disclosure Form Title
219 N. Hart St., PO Box 13 Partenheimer, Kinkle 8 Ricker
Address(Number and Street) Company
Princeton, IN 47670 812-386-0050 irkinkleaehok-law.com
Cloy,State,and ZIP Code Telephone Number E-mail
E"SELL'ER(S)/,GR;4NTOR(S)a t, . , ;r.g >:a ❑a w a ' L3 e Mza - t:'' i. __ :_.,°•, `' • , rc'DI
.. --see aS.-._:a_. aJ_.s _-�.s as'-: .a �. .,,_.5+..,e._s.�a.a...r:...-,rasa i u:f-e,Aa ., u
The Estate of Paula J Eagan
Seller]-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
7051 E 450 N
Address(Number and Street) Address(Number and Street)
Francisco IN 47649
City,State,and ZIP Code City,State,and ZIP Code
812-746-0871
Telephone Number 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 c mplete as required( bye law,and is prep�ared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
�3 \Qw� v < W\t re�t0p
Signature of Seller Signature of Seller
Shannel R Whitehead Unsiin Pers Ren 8/29/2019
Printed Name of Seller Sian Date(MM/DD/Yrr1) Printed Name of Seller ..3Vgn Date IMM/DO/rrri1
F. BUYERLS)%GRANTEE(S =.APP.LIGATION,FOR•PROPERTYTAX:DEDUCTIONS IDENTIFY A'LL ITEMS THA'fe$,V • le<LL - j
Jamond R. Heldt ��Q(�c�F Prehst‘ e�O
Suver1-Name as appears on conveyance document Buyer 2-Name as appears on contau5irldac` 1•a
�1C\'-' o
1805 S. Main Street 0V) •c Voa� V.ot t,
Address(Number and Street) Address(Number and Streetll.`eo- ,ok O Cat`
IN 47670 S�aa' e✓ G`bs ---
Princeton,
City,State,and ZIP Code City,State,and ZIP Code n 1(
lµJj--C�r/'
812-677-4671 �"�d:.
Telephone Number E-mail Telephone Number 'Air E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF HOS\THAT. PLY AP .
YES NO CONDITION I NO CONDITION tL
❑ El1.Will this property be the buyer's primary Z ❑ 3. Homestead
residence? Provide complete address of primary` . , oar Energy Heating/Cooling System
residence,including county:
6837E 400 N ❑ Ill 5.Wind Power Device
Address(Number and Street) ❑ Q 6. Hydroelectric Power Device
Francisco, IN 47649 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 ❑ 8. Is this property a residential rental property?
vacated for this residence? If yes, provide ❑ g 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.
1805 S. Main Street Not available in all counties.)
Address(Number and Street) �y1 ,.(/
Princeton, IN 47670 Gibson Jamond R.Heldt Zia,- ZQ- _ .R O/7
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
and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". (Note:
Spouse information,• ocial Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
being fil�
Signature of Buyerl Signature of Buyer2/Spouse
lamond R HPldt 8/29/2019
Printed Legal Name of Buyer I Sign Date(.MM/a0/YYY1) Printed Legal Name of Buyer 2/Spouse Sign Date(MM/DD/YYYY)
r9QO @ 3 IN 393L( 7
Last 5 digits of Buyer I Driver's State Last 5 Digits of Social Security Number Lost 5 digits of Buyer 2/Spouse Driver's State Last 5 Digits of Social Security
License/ID/Other Number Number License/ID/Other Number