Homestead_Stiles INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER
Cody L Pruett Escrow Officer 1
Preparer of the Sales Disclosure Form Tide
4600 Washington Avenue,Suite 102 Regional Land Title Company
Address(Number and Street)
E-mail
E.SELLER S: .GRANT(}R S
Shirley Ann Romershausen Revocable Trust dated February 20,
4 nn ^^
Pi 1-Name as appears on conveyance document Seller2-Name as appears on conveyance document
/o rl Barr, Ategrje 2/9
Address(Number and Street) Address(Number and Street)
yam"SZ¢P'7, .z u 11439
City,State,and ZIP Code City,State,and ZIP Code
E-mail Telephone Number E.mnll
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
and mplete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Signature of Seller Signature of Seller
Brett K.Romershausen December 22, December 22,
Printed None ofSeler Sign Date(A}M/?DhY1Y31 l Printed Name o(Seller Sign Date rAf/DU/Yym
F,BUYER S)fGRANTEE(S).-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDDNTII YALL ITEMS THAT APPLY
John Stiles
Buyer 1-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
7 7c Z .5 t. A7 4y el I
Address(Number and Street) V Address(Number and Street)
t T,15rAwc# T,ra;A.✓,4 L 7& yg
E•mall Telephone Number Dec 29 2020 E-mail
THE SALES DISCLOSURE FORM MAY RE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY. /I�
YES NO CONDITION YES NO CONDITION JM�1•','
4110
Q( ❑ 1.Will this property be the buyer's primary vj ❑ 3.Homestead GIBSON COUNTY AUDITOR CB
residence? Provide complete address of primary ❑
residence,including county: 4.Solar Energy Heating/Cooling System
7S 2- S Lt•S 1-i;�inv9 y y 1 ❑ ® 5.Wind Power Device
;dress Number'andStreet) ❑ Zi 6.Hydroelectric Power Device
' &4"Ic H -TuDIA"'4 y 74 y 6 ❑ 7.Geothermal Energy Heating/Cooling Device
City State ill'Code County
Er ❑ 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 ❑ V 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.
516 1/T 5T Al.w Not available in all counties.)
Address'(Number.nnd Street)
Li i QN _A✓DON4 UU 7 L,y I John Stiles 26-19-19-200-001.220-026
City,State ZIP Code County
Primary property owner contact name E-mail