Homestead_DeHaven (2) INDIANA SALES DISCLOSURE FORM SDF ID: 2020 Page
O. PREPARER
• Amy B Pollard Escrow Officer
,onarer of the Sales Disclosure Form Title
• SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
,,tress(Number and Street) Company •
•mnsville, Indiana 47713 (
E-mail
`; LLER(S)/GRANTOR(S)
Adajryt6arm,Agent 3*FI .bEN '<oPiy,E1 l__-► bg i>S�af ���mK 3
'er 1 -Name as appears on conveyance document Seller 2-Name as appears on conveyance document
504 E. SR 68
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639
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 complete as re ' d by law,and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Lvrr''
Signature of Sel r Signature of Seller
Adam Gann,Agent I I& b0 O
Printed Name of Seller Sign Date(MM/DD YYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
-. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS TH T APPLY
1 t L'-'I(W. DeHaven
".yer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance do
57E- SR 68,Apt 301 '
o%r+ess(Number and Street) Address(Number and Street) ✓,9A, .41:6
iatik+at IN 47639 X
.r
E-mail Telephone Number OU E-mail
i `HE SAL S DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF fe H T APPLY.
YES NO CONDITION YES NO CONDITION `1G/)/
0 1. Will this property be the buyer's primary / 0 3. Homestead r04,
residence? Provide complete address of primary ❑ El 4. Solar Energy Heating/Cooling System
residence, including county:
2624 W Jill Dr. 0 El 5. Wind Power Device
Address(Number and Street) 0 RI 6. Hydroelectric Power Device
_...._......_...._....._......___._._._.....__.._.___.___._.__..__.._..._..._..._._..._............._.._..........._.:._ 0 El 7. Geothermal EnergyHeating/Cooling Device
:Princeton, IN 476 0 Gibson.. g g
City, State ZIP ode County 0 RI 8. Is this property a residential rental property?
0 2. Does the buyer have a homestead in Indiana to be 0 RI 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete property via-email? (Provide contact information
I address of residence being vacated, including county: below. Please see instructions for more information.
I Not available in all counties.)
,'unass(Number and Street)
ag—//—/ -/Q/— 2 f. 7/.5=4 1 ? 2
License/ID/Other Number