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INDIANA SALES DISCLOSURE FORM SDF ID: Page 2
D.PREPARER
Claire Kincaid Closing Agent
Preparer of the Safes Disclosure Form Title
501 Main Street,Suite 101 Bosse Title Company,LLC
Address(Number end Street)
_ E-mail
E.SELLER(S)/GRANTOR(S)
Estate of Phyllis G.Mayberry
Seger 1-Name asappeors on conveyance document Seller2-Name as appears on conveyance document
308 N.Main St.
Address(Number and Street) Address(Number and Street)
Owensville,IN 47665 -
City,
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
complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".
Q., `Mar.,.,,,---
Signature g Signature ofSeller
Judy A orrison,Personal Representative 12/29/2020
Printed Name of Seller S(gn Date(MM/DD/YY') Printed Name ofSeller Sign Date MA/DO/MY)
F.BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL ITEMS THAT APPLY
Tara Newton
Bayer I-Name as appears on conveyance document Royer-Name as appears an conveyance document
306 N.Main St.
Address(Number and Street) Address(Number and Street)
Owensville,IN 47665 FILED
DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE THAT APPLY. Y/.e""" ^"
NO CONDITION YES NO CONDITION 1�� " J
"
El 1.Will this propertybe the buyer's primary Imo, ❑ 3.Homestead GIBBON COUNTY AUDITOR CB
residence? Provide complete address of primary
residence,including county: ❑ 0 4.Solar Energy Heating/Cooling System
❑ 0 5.Wind Power Device
308 N.Main St. ❑ 0 6.Hydroelectric Power Device
Address(Number and Street) ❑ []X 7.Geothermal Energy Heating/Cooling Device
Owensville,IN 47665 Gibson ❑ 0 8.Is this property a residential rental property?
City,State ZIP Code County
❑ El 9.Would you like to receive tax statements for this
0 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(Number and Street)
26-17-01-404-000.111-022
City,Scare ZIP Code County Primary properry owner contact name E-mail
License/ID/Other Number