Homestead_Goebel (2) INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D PREPAREk t 'li
Rexanne McCauley Title& Escrow Processing
Preparer of the Sales Disclosure Form Title
3930 Mezzanine Drive, Ste C Columbia Title, Inc.
Address(Number and Street) Company
Lafayette, IN 47905
mail
E SELLER(S)%GRANTOR(S):__ 1,', `- .. ;. !,> -'
Jeremy S. Mayer Melissa C. Mayer
Seller 1-Name as appears on c ve once document Seller2-Name as appears on nve once document
`�00 nrl��G d_. 100 ROM T
Address(Number a d Strret) ress Number and tr et)
an v)2le I i 11T 1 thQcVil se )01 L/7a-
City,
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 omplete as equired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
AI)? OAOAAAC.()C,- CV\CI\1\n
Signature o ller Signature of Seller
Jeremy S. Mayer /6-d/-do/9 - . -r t - ' 1
Printed Name o Seller Si.n Date(MM DD/YYYY) Printed Name o Seller
Si'n Date.(MM/D i/YYYY)
FDavid L. GoebelS _ R P APPLICATION FOROPERTY TAX DEDUCTIONS-,IDENTIFY ALL ITEM -S;_ •P `
r
' Cindy L. Goebel '
Buyer • . conveyance document Buyer 2-Name. .• son conveyance document
1644 East Autumn Ridge Ib44 Effa7 utumn Ridge oCT
Address(Number and Street) Address(Number and Street) 2049
Haubstadt, IN 47639 Haubstadt, IN 47639
r, ii
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. iiDiTO /,P✓loj(,LD+A
YES NO CONDITION NO CONDITION �k./
I ❑ 1.Will this property be the buyer's primary [ ❑ 3.Homestead
residence? Provide complete address of prima .......__r2- •_,.,f; - nergy Heating/Cooling System
esI enc ,rn ludin co ty• ❑
l n q(, n, - nAu b, r r 5.Wind Power Device
A d (N mb ra Street U� .- ❑ El 6.Hydroelectric'Power Device
❑ ® 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Co e County
J El 2.Does the buyer have a homestead in Indiana to be III Vil 8•Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ IN 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
Wang county: ' below.Please see instructions for more information.
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2U� ,((, i I i ve. Not available in all counties.)
Addres umberd Str 0 . ,1V Vadh, ii olz,- -� oa -oo . 4,....„7,,,.
City,Sta'fe ZIP Code Cr¢urrty
v Primary property owner contact name E-mail