Homestead_Breidenbaugh INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER
Christina Lenfers closing agent
Preparerof the Sales Disclosure Form Title
501 Main Street,Suite 101 Bosse Title Company,LLC
Address(Number and Street) Company
Evansville,IN 47708 (
-
E-mail
E.SELLER(S)/GRANTOR(S)
Jeffery L Sullivan Theresia L.Sullivan
Seller I-Name as appears on conveyance document Seller2-Name as appears on conveyance document
2910 E.400 N. 2910 E.400 N.
Address(Number and Street) Address(Numberand Street),
Patoka,IN 47666 Patoka,IN 47666
✓ 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 omple as r quir b law,and is prepared in accordance with IC 6 .1-5.5,"Real Prop ales Disclosure Act".
,
onto o II Signature ofSeller
effery L ullivan 02/04/2020 Theresia L.Sullivan 02/04/2020
Printed Name ofSeller Sign Date(MM/DD/YYYY) Printed Name ofSeller Sign Date(MM/DD/YYYY)
F.BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
Mitch Breidenbaugh Marissa Breidenbaugh
Buyer I-Name as appears on conveyance document Buyer2-Name as appears on conveyance document
2373 E.Top Hat Rd. 2373 E.Top Hat Rd.
Address(Number and Street) Address(Nunberand Street)
Princeton,IN 47670 Princeton,IN 47670 FILED
E-mail Telephone Number Feb 12 2020 E-mail
THE S LES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY. AftlOgt—
V1
NO CONDITION YES NO CONDmON
1 1.Will this property be the buyer's primary ❑ 3.Homestead GIBSON COUNTY AUDITOR CB
residence? Provide complete address of primary 4.Solar Energy Heating/Cooling System
residence,including county: ❑
�. 5.Wind Power Device
2910 E.400 N. ❑ 7.4 6.Hydroelectric Power Device
Address(Number and Street) ❑ 'r 7.Geothermal Energy Heating/Cooling Device
Patoka,IN 47666 Gibson ❑ 74 8.Is this property a residential rental property?
Ciry,State ZIP Code County
t7( CI �i 9.Would you like to receive tax statements for this
❑ 2.Does the buyer have a homestead in Indiana to be property via e-mail? (Provide contact information
vacated for this residence? If yes,provide below.Please see instructions for more information.
complete address of residence being vacated, Not available in all counties.)
a 3cludityyhi
Rd
Ad (NjtmberandStr t) s
rrl and Street)
- — 1 ci7 ?o 61Pscy\ 26-02-22-000-003. 732-017
City.State ZIP Code County Primary property owner contact name E-mail