Homestead_Mayer (9) INDIANA SALES DISCLOSURE FORM SDF ID: • Page 2
D PREPARER . - — .• = "
Patti Kolb Closing Manager
Preparer of the Sales Disclosure Form Title
226 W Broadway St. Broadway Title. Inc.
Address(Number and Street) Company
Princeton, IN 47670
E-mail
E_SELLER(S)/GRANTO.R(S-)_,___---=- ------ --:--- - -_ _ ___- --__1__1- --- ---
Jill M (Frederick)Roudebush
Seller 1-Name as appears qn oonrjwnc cum atLi_ Seller 2-Name as appears on conveyance document
107 N Fileen St. '1�n1 1 '
Address(Number and Street)ff��� I + rL �(� Address(Number and Street)
Haubstadt IN 47639 �``�e s , { l `� "� �`c262s-
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
jjj ompl
•to as require y law,at is pr ared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
' 0 IY11
or attire of Seller � Signature of Seller
if 1/ :• ..- /I . I 3/O 2O ?o
Printed Name of Seller Sign Date IMM/DD/YYYY) Printed Name of Seller Sign Date(MM/DD/YYYY)
- - —'_ "' NTEE(S)- APPLIGATION_FOR PROPERTY TAXD:EDUCT�IONSIDENTIFY ALL_ITEMS.THATAPPLY-;, _ ,_._l
' Lucas A. Mayer
Juver 1-Na• 'pears on conveyance document Buyer 2-Name as appears onuyer Name as appears convey do�m ED___:.,
952 W 1000 S
Address(Number and Street) Address(Number and Street)
Haubstadt, IN 47639 MAR 5 2020
BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROP • '•. 0 ENTIF • a CHOGI AJIVTY AUDITOR
, YES NO CONDITION 'ES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead
residence? Provide complete address of primary ' -ZZinumn— , , Enervk 'eating/Cooling System
residence,including county:
El .
107 N Fileen St. 5.Wind Power Device
Address(Number and Street) ❑ 0 6.Hydroelectric Power Device
Haubstadt, IN 47639 Gibson ❑ Z 7. Geothermal Energy Heating/Cooling Device
City,State Zl Code County
❑ 2. Does the buyer have a homestead in Indiana to be El ❑✓ 8.Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ z 9.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail? Provide contact information
including county: belo ase see instructions re information.
of available in all counties.)
Address(Number and Street) 1
City,State ZIP Code County -L s-3 G ` I `p 2_ 0 O0 3 8 2 _ °rJc
•r(mary property owner contact name E- ail
Number License/ID/Other Number
I