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Homestead_George INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 }. �Ab p —q T'i� 'ti :?�3 „vye x W g. .i >. 'a. s yo c4 ~. '.14 ` v➢�sy` i at r "^«S $$ Gg,r. SAniwlmz4,, x.sh :k,w5 k�,apzgeii TM , .. , - _ A: ,R'1-AA € .:41Zy?3-Z,d ,TIAk74,i, Y� 4 { ;=.g # r 1-*Z.s. s Justin Schmitt AVP, Loan Officer Preparer of the Sales Disclosure Form Title 11201 Upper Mt Vernon Rd Community State Bank of Southwestern Indiana Address(Number and Street) Company Evansville, IN 47712 TEUMWAWROICIOM. '4•,: .:`V-_ .'.. I-: . _ ., ,",.-aa_1iitigka,kiV�,�*='r+W .^Ri Dana R. George Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 107 S Willard Street Address(Number and Street) Address(Number and Street) Fort Branch IN 47648 r 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 c ppllete ash r�uir by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". t1. cfc Signature of Seller Signature of Seller Dana R.George Printed Name o Seller Sign Date(MM DD/YI'Yll Printed Name of Seller Srgn Date(MM/DD/YYYY) 03 :.. 2p''L1CAiP7Q �'_,0 =M O FER PY`TAX I)EEI C U r1(i VB elt.t+YFA L I'� °I!'( ',z " #P~,At� ,.: `'? "._.;• hristooher W. George Buyer 1-Name as appears on c 'ance document 4 Buyer 2-Name as appears on conveyance document 5779$275 E Address(Number and Street) Address(Number and Street) Fort Branch,IN 47648 City,State,and ZIP Code City,State,and ZIP Code E-mail Telephone Number E-mail THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERT E THAT APPLY. YES NO CONDITION NO CONDITION ILED z ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead Ma}�1 2020 residence? Provide complete address of primar Cn1r Fne ating/Cools ys e residence,including county: 5779 S275 F ❑ 05.Wind Power Device Address(Number and Street) ❑ ❑ 6.Hydroelectric Power Dl1l COUNTY AUDITOR CB Fort Branch, IN 47648 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ 0 2.Does the buyer have a homestead in Indiana to be ❑ ❑✓ 8.Is this property a residential rental property? vacated for this residence? If yes,provide ❑ 0 9.Wo ice to receive tax statements for this complete address of residence being vacated, property via e-mail? contact information including county: below.Please see instructions for e information. 26-19-1tt` bblblogl1:2 lesd25 Address(Number and Street) hristopher W.George City,State ZIP Code County Primary property owner contact-Ifame E-mail Number License/ID/Other Number