Homestead_Hightower (2) 11Y lJ1AlYA JALLJ 11 aJ Vl.VJV a.a.a V a.a•a ✓�. .a.r.
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Kimberly A. Racey Closer
Preparer of the Sales Disclosure Form Title
606 Main Street Dubois County Title Co., Inc.
Address(Number and Street)
City,State,and ZIP Code Telephone Number E-mail
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Philip J. Bromm
Seller 1-Name as appears on conveyance document Seller 2-Name as appears on conveyance document
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AddressfNu berand Street) Address(Number and Street)
City,State,and
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 co et as rA law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
111111 7►� a�`o� d
• Signature of Seller Signature of Seller
Philip J. Bromm 5/29/2020
Printed Namv nFSeller Sign Date(MM/DD/YYYY) Printed Name ofSeller Sign Date(MM/DD/YYYY)
illi ,l'1.I,C,E TION O.TR0,PEIZ l 1'rIMOVI lCTI0 i5 ' iTEMTRIM I E IS TIL' 1A MINI x EE
K-yla M. Hightower
uyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
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Address(Number and Street) Address(Number and Street)
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City,State,
DEDUCTIONS FOR THIS PROPER -OSE THAT APPLY. FILED
YES NO CONDITION 'ES NO CONDITION
Ilf ❑ 1.Will this property be the buyer's primary Uri ❑ ..Homestead Jun 04 2020
residence? Provide complete address of primary Z Pl'`._ ; ;_._ :- -ating/Coo
residence,including county:
❑ C Wind Power Device GIBSON COUNTY AUDITOR CB
Address(Num S, e{ ❑ �^�.Hydroelectric Power Device
� L�, �`n ❑ L' 7.Geothermal Energy Heating/Cooling Device
City,State ZIP Code County
❑ V 2.Does the buyer have a homestead in Indiana to be ❑ Is this property a residential rental property?
vacated for this residence? If yes,provide ❑ 9.Would you like to receive tax statements for this
complete address of residence being vacated, roe - 'I? Provide contact information
including county: below.Please see instruction re information.
Not available in all counties.)
Address(Number and Street) 26-14-18-304-000. 880-007
City,State ZIP Code Coun
ary property ela.,..«„u� E-mail
'
/ Number License/ID/Other Number