Homestead_Lutz (6) II�NDIIApNpA�SALES DISCLOSURE FORM SDF ID: Page 2
WOMB J.133.1Cf`►.{!F3' ti TE. ' ".s-' a. *•-.e sie++;- ir. rg., f-nC, t 1 '..sty•fr?. xr a •:,• 'tom'.ti*- '- 4'47✓a' '"4`vf5 f" i •mt,
Chris Sullivan Closer
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Ste 201 Regional Title Services
Address(Number and Street)
.71- ,..i __w. "+ -1 s'1 ." ?.; _ 'r° , 7'- -P 7+ :c.r 91ux.i` 2,: c•,�Y.. - v
-r'`�. ,:.: o � `; E �" `�`'4;� Jfi.�'. :��P' �p i it 5�"�"1� '�'F''u+'..�. �ti.. � 2 �q,:.r., 6.Ix., 7`s 5. s"t�T�[�`-�'f, '` - `'ryy, .c..
Jay Emmert
Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document
102 N Vine St 102 N Vine St
Address(Number and Street) Address(Number and Street)
Haubstadt,IN 47639 Haubstadt,IN 47639
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 uired by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
S n re ofSeller Signature ofSeller
Ja mmert
Printed Name ofSeller Sign to( M/DD/Yri7) Printed Name of Seller Sign Date(MM/DD/YYYY)
t'• 7 =1311 i811:e" r f(' s. 11' 0A-11•I0.RO' PRO'ER '.> .A7�(D "IlU ,ira .iDl13NTIR- AL r.I aPIiAV AtPPE % ,
Emily Lutz
Bu • e' ••, •rs on conveyance document Buyer 2-Name as appears on conveyance document
105 W 3rd Ave 105 W 3rd Ave
Address(Number and Street) Address(Number and Street)
Haubstadt,IN 47639 Haubstadt,IN 47639
Telephone Number I LED E-mail
THE SALE DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPE L OF THOSE THAT APPLY.May 1 9 2020
YES NO CONDITION YES NO CONDITION 41,4Lacgd ^+--
❑ 1.Will this property be the buyer's primary ❑ 3.Homestead GIBSON COUNTY AUDITOR CB
residence? Provide complete address of primary I-1 El 4 SDt Rnergy Heating/Cooling System
residence,including county: ❑ El 5.Wind Power Device
102 N Vine St
Address(Number and Street) ❑ 21 6.Hydroelectric Power Device
Haubstadt, 47639 Gibson ❑ El Geothermal Energy Heating/Cooling Device
City,State Z Code County ❑ e/ 8.Is this property a residential rental property?
❑ 2.Does the buyer have a homestead in Indiana to be ❑ 0 9.Would you like to receive tax statements for this
vacated for this residence? If yes,provide property via e-mail? ' e contact information
complete address of residence being vacated,
including county: below se see instructions for mo rmation.
Dla available in all counties.)
Address(Number and Street) Emily z 26-19-31-301-000. 100-009
Number License/ID/Other Number