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Homestead_Hillyer INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER
KAIEN HARBISON VP
Preparer of the Sales Disclosure Form Title
803 E STATE RD 68 THE HAUBSTADT STATE BANK
Address(Number and Street) Company
HAUBSTADT IN 47693
E.SELLER(S)/GRANTOR(S) -
SARAH A CFNFY.TRUSTFF OF THE SARAH A CFNFY LIVING TRUST dated May 6th 2016
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
914 TAVFRSHAM AVE
Address(Number and Street) Address(Number and Street)
FVANSVILLF IN 47725
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 Fequped by law,I d is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
UUNnt,1R,,
ignature ofSeller Signature ofSeller
FILED
SARAH A GFNFY-TRUSTEE 5--['-I-20a0
Printed Name ofSeller Sign Date(MM/DD/YYYY) Printed Name ofSeller w on on ( �Sign Date(MM/DD/YYYY)
F.BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY r1Ll.YI PISLMT APPLY _ f
7,-.7S11ARON R HIL.LYER
i ?
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears o za nt�'%
157 3 STATE RD 68 APT 206 GIBSON COUNTY AUDITOR
Address(Number and Street) Address(Number and Street)
HAUBSTADT IN 47639
E-mail Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary 071 ❑ 3.Homestead-1
residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System
residence,including county:
525 S NINTH AVF ❑ ❑✓ 5.Wind Power Device
Address(Number and Street) ❑ IZ 6.Hydroelectric Power Device
HAUBSTADT IN 47639 GIBSON ❑ Z 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
E 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.Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail?(Provide contact information
including county: below.Please see instructions for more information.
Not available in all counties.)
Address(Number and Street) ��() 2 [�
City,State ZIP Code County � p' .=lr�/c,` p' ��"'`•`�� `�=�� J-__�
License/ID/Other Number