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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER ,, :- .: . . .. .
THOMAS L.MONTGOMERY GENERAL MANAGER
Preparer of the Sales Disclosure Form Title
101 PLAZA EAST BLVD.,STE. 102 TRUE TITLE SERVICE, LLC
Address(Number and Street)
mail
ANDREW HAGEN
Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document
11901 Griffin Road -, t
!dress(Number and Street) Address(Number and Street) it--1'
Griffin,IN 47616
ate,and ZIP Code State,and ZIP Code
/
mail Telephone Number ,� E-mail
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledg• ; . f. , s tr4 orrect
and corn lete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Proper '1:`.i t le sure Act".
GVBS°N
Signature of Seller Signature of Seller
ANDREW HAGEN 9- /-3o /2019
Printed Name of Seller Sign Date(MM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
F.BUYER(S I/.GRANTEE(S)-APPLICATION FOR PROPERTY TAX.DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
=USTIN_J._M.ONTGQMERY-) i—ATYSSA M. YBARRA—___//
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
6685 N.Holdaway Place 6685 N.Holdaway Place
(dress(Number and Street) Address(Number and Street)
West Terre Haute,IN 47885 West Terre Haute,IN 47885
E-mail
FHE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION __
197
❑ 1.Will this property be the buyer's primary t D-3-Homestead--
residence? Provide complete address of primary ❑ Q 4.Solar Energy Heating/Cooling System
residence,including county: ❑ 2 5.Wind Power Device
8873 S Meadow LN
Address(Number and Street) ❑ 2 6.Hydroelectric Power Device
Owensville,IN 47638 Gibson ❑ p 7.Geothermal Energy Heating/Cooling Device
City,Statezl ode County ❑ Ty8.Is this property a residential rental property?
❑ 2.Does the buyer have a homestead in Indiana to be Wouldyou like to
vacated for this residence? If yes,provide Elg 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 available7 in all counties.) !-��3-so21
Address(Number and Street) Z o-1 /-29-'Y®Y-QOT
AUSTIN J. MONTGOMERY&ALYSSA M. YBARRA
City,State ZIP Code County Primary property owner contact name E-mail