Homestead_Fobes INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D PREPARER __ : . -._ __ _ ___ t __..a r_ r. Y. z a „ 5 7
Amanda Daly Closer
Preparer of the Sales Disclosure Form Title
7820 Eagle Crest Blvd Ste 201 Regional Title Services
Address(Number and Street)
3�, r er - -.;,s. 1 �'as.. F. .-:r V,L i'f` - ` N f` ^e F; _
Jaelyn L. Smith Coltin A. Smith
Seller 1-Name as appears on conveyance document Seller 1-Name as appears on conveyance document
102 N.Campbell Blvd 102 N. Campbell Blvd
Address(Number and Street) Address(Number and Street)
Haubstadt,IN 47639 Haubstadt,IN 47639
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 compl as re uired by law,and is prepared in accordance with ICC4
6-1. 5. "' .1 Property Sales Disclosure Act".
t.‘\ 1 "
S g ,lure of Iler l /2efta
Signature of Seller ��JaelynL.Smith / &/ Coltin A. Smith 3(fPrinted Name ofSeller Sig(,Date(MfM/DD/YYY1) Printed Name of Seller Sign Date hff,I DD
6 '.. �;71rEE(Sl,; .APPLICATION F.ORPROPERTY T' ,XtDED.U&TIONgaD-ENTIEYrALL;I.TEMS TflAlr'APPLi-Y -S.> :.e W N
Betty J.Fobes
7Address(Number and Street)
�6 J IA) Elm ill,
Telephone Number E-mail
Aug 03 2020
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY_IDENTIFYALL OF THOSE THAT APPLY.
YES NO CONDITION S i NO CONDITION
❑ 1.Will this property be the buyer's primary 3.Homestead GIBSON COUNTY AUDITOR CB
residence? Provide complete address of primary Q 4. o a eating/Cooling System
residence,including county: ❑ Q 5.Wind Power Device
102 N Campbell Blvd
Address(Number and Street) ❑ L( 6.Hydroelectric Power Device
Haubstadt,IN 47639 Gibson ❑ Q 7.Geothermal Energy Heating/Cooling Device
City,S te ZIP Code County ❑ 8.Is this property a residential rental property?
❑ 2.Does the buyer have a homestead in Indiana to be ❑ 9.Would you like to receive tax statements for this
vacated for this residence? If yes,provide property via e-mail?(Provide contact information
complete address of residence being vacated, below.Plea . in ormation.
including county: N.. : ailable in all counties.)
Address(NumberandStreet) Betty J.F'bes 26-18-36-401-000. 647-009
City,State ZIP Code County Primary property owner contac nam
Number License/ID/Other Number