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Homestead_Holder (3)
INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D.:PREPARER.._, _ _ ... -_ .._ -. Roman Ricker Attorney Preparer of the Sales Disclosure Form Title 219 N. Hart St., PO Box 13 Partenheimer, Kinkle&Ricker Address(Number and Street) Company Princeton, IN 47670 E-mail • E:_SELLER(S)/.GRANTQR(S). .- _ __ .. _ •_ .- . _ ,:.--::.,.,K--:.:;-: __ _ ., The Fstate of Doris M. Flpers Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 400 F Walnut Street Address(Number and Street) Address(Number and Street) Fort Branch, IN 47648 City,State,and ZIP Code City,State,and ZIP Code 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 cRmp�required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act'. Signature of Seller �� Signature ofSeller Pamela C. Betz, Unsup. Pers. Rep. 10/11/2019 Printed Name o/'Seller Sign Dote(MM/DD/YYYYJ Printed Name of Seller Sign Date(MM/DD/YYYY] F_BUYER(S)/GRANTEE(S) ,APPLICATIDN.FOR PROPERTY TAX_DEDUCTI:ONS IDENTIFY_ALLITEMS THAT_,_ LY__,_ _ ___ i Bruce E. Holder Sher K. Holder Buyer 1-Name as appears on conveyance document ' Buyer 2-Name as appears on conveyance document 905 Chickasaw Drive 905 Chickasaw Drive Address(Number and Street) Address(Number and Street) oc Fort Branch, IN 47648 Fort Branch, IN 47648 C jt� j Telephone Number E-mail Telephone Number C0 E-mail THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY. Ail y — YES NO CONDITION YES NO CONDITION ) -. Z ❑ 1.Will this property be the buyer's primary Zl ❑ 3.Homestead residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: 610 F.Park Street El ❑✓ 5.Wind Power Device Address(Number and Street) ❑ 0 6.Hydroelectric Power Device Fort Branch, IN 47648 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County 0 ❑ 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 ❑ z 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. 905 Chickasaw Drive Not available in all counties.)_ Address(Number and Street) oX -/g-/f/0(J -Qo Q•/.9 - 6,.? Fort Branch, IN 47648 Gibson Bruce E.&Sherry K.Holder City,State ZIP Code County Primary property owner contact name E-mail