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Homestead_Heldt INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 D.PREPARER Jeff Bosse Proparer of the Sales Disclosure Form Title 501 Main Street,Suite 101 Bosse Title Company,LLC Address(Numberand Street) E-mail E.SELLER(S)/GRANTOR(S) Estate of Mary Ellen Ziliak Seller I-Name as appears on conveyance document Seller 2-Name as appears on conveyance document 12136 S.50 W. Address(Number and Street) Address(Number and Street) 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 a1r mplete a e 're y la ,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". .nature Her Signature ofSeller Joseph Ziliak,Personal Representative 07/31/2020 07/31/2020 Printed Name ofSeller Sign Date(MM/DD/YYYY) Printed Name ofSeller Sign Date(MM/DD/YYYY) CFL3UYER(S)/G EE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY icholas L.Heldt oyes - nce document Buyer 2-Name as appears on conveyance document 11160 Watertank Rd. Address(Number and Street) Address(Numberand Street) Cynthiana,IN 47612 USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.I OF THOSE Y. •-• YES NO CONDITION YES NO CONDITION e"��S�"' � ���"• cbt © ❑ 1.•Will this property be the buyer's primary ] ❑ 3.Homestead SON'COUNTY AUDITOR CB residence? Provide complete address of primary residence,including county: El El4.Solar Energy Heating/Cooling System ❑ El 5.Wind Power Device 12136 S.50 W. ❑ CO 6.Hydroelectric Power Device Address(Numberand Street) ❑ © 7.Geothermal Energy Heating/Cooling Device Haubstadt,IN 47639 Gibson ❑ El 8.Is this property a residential rental property? City,State ZIP Code County ❑ ® 9.Would you like to receive tax statements for this ❑ 'R] 2.Does the buyer have a homestead in Indiana to be property via e-mail? (Provide contact information vacated for this residence? If yes,provide below.Please see instructions for more information. complete address of residence being vacated, Not available in all counties.) including county: • Address(Numberand Street) 26-23-18-100-000. 597-024 City,State ZIP Code Coun• Primary property owner contact name E-mail License/ID/Other Number