Homestead_Beuligmann (2) INDIANASALES DISCLOSURE FORM SDF ID
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Timothy Shea Closing Services
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Ste 201 Regional Title Services _
Address(Number and Street)
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Debra K.Riley
Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document
5239 S State Road 65
Address(Number and Street) Address(Number and Street)
Owensville,IN 47665
state,and ZIP code state,and sir cone
/01.
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 complete as required b law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature ofSeller / Signature of Seller
Debra K.Riley I(-(a-VCl
P ame ofSeller Sign Date(MM/DD/YYYYJ Printed Name of Seller Sign Date(MM/DD/YYYY)
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Matthew Bernard Beuligmann Denia Marie Beuligmann
er 1- ame as a eyancerailment Buyer 2-Name as appears on conveyance document
7107 400 S 7107 W 400 S '
Address(Number and Street) Address(Number and Street)
Owensville,IN 47665 Owensville,IN 47665
IE-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIPROPERTY. IDENTIFYA1 L• THOSE THAT APPLY. FILED
YES NO CONDITION YES NO CONDITION
Nov 15 2019
.® ❑ 1.Will this property be the buyer's primary ❑ 3.Homestead J ��,,
residence? Provide complete address of primary ng/Coolfti�'�r—
residence,including county: ❑ WI 5.Wind Power Device GIBSON COUNTY AUDITOR CB
5239 S State Road 65
Address(Number and Street) ❑ Q 6.Hydroelectric Power Device
Owensville,IN 47665 Gibson ❑ Ii4 7.Geothermal Energy Heating/Cooling Device
City,State ZI,5 de County ❑ 0 8.Is this property a residential rental property?
❑ Lr 2.Does the buyer have a homestead in Indiana to be ❑ 9.Would ou like to receive tax statements for this
vacated for this residence? If yes,provide property via l?fP ide contact information
complete address of residence being vacated, / below.Please see instructions ore information.
including county: Not available in all counties.)
Address(Number and Street) Q26-17-01-400-003. 702-021 !Matthew Bernard Beuligmann Denia Marie Beuligmn /
City,State ZIP Code County Primary property o n ame E-mbil