Homestead_Ungethiem INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
Christina Latham Title Clerk
Preparer of the Sales Disclosure Form Title
4703 Theatre Drive Regional Land Title
Address(Number and Street)
mail
SPM Development, Inc dba Reinbrecht Homes
Seller 1-Name as appears on cony once d ument tas, Seller 2-Name as appears on conveyance document
-" auf E-- as+. -
Add ess(Numbfr and treet) Address(Number and Street)
4- ,t) c/7639
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 by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
S
1..911.g t u e er Signature of Seller
SPM Development. Inc.dba Reinbrecht Homes lit--A- /9
Prince e er Sign Date(MM/DD/YY0 Printed Name of Seller Sign Date(MM/DD/YYYY)
.
_th ti i 18i latASittg(Si ''' PPLIC.A7TION- OkPIZOPERTY TAX.DEDUCTIONSJUNTIFYALL ITEMS:THATAPPa
"'Amber N. Ungethiem ; •con yance doc I ,
,. .Bu e - . -yrs on,co,vzonfe document 7 Buyer 2-Name as appears on ve 41 nt
,P 69—Dk ld' s
••.• • — i 4
Adi rg s(It/umber an Srrget)/ ,,,, ,____44/ Address
/ (//i2 119/1(I CPI / L-/ -*--7-06 NO
City,State,
E-mail Telephone Number I d. E-mail
THE SAL 'DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THA PPM L'I
- AI.1..1,,
YES NO CONDITION NO CONDITIO . •11/11)e-.--
Oke
0 1.Will this property be the buyer's primary Z 0 3.Homestead
residence? Provide complete address of prim.' E N , e . •• , -eating/Cooling System
residence,including county:
0 El S.Wind Power Device
1411 W.Chukar Hollow Road
Address(Number and Street) E IZ 6.Hydroelectric Power Device
Haubstadt, IN 47639 Gibson E Z 7.Geothermal Energy Heating/Cooling Device
City, ate ZIP Code County
El 111 8.Is this property a residential rental property?
0 2.Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes,provide El Z 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
inclu I ing county: below.Please see instructions for more information.
11,5.Oa, :. 1P gind,6_ Not available in all counties.)
Address(Number and Street)
UatIkfi.0 1 1L-P---c---Lei) 477071 (•)at ft-6-110 00 dC-/g-13-6 -3•6v . oca.7n-/-60
City,State ZIP Code County
Primary property owner contact name E-mail
Number License/ID/Other Number