- McPhee, Dixie_1/10/2022 SALES DISCLOSURE FORM
1.,-,- "-rF State Form 46021 (R12/1-21) SDF ID Gibson 2021
,/ "-cyr?% CountyYear Unique ID
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N4;�-~;2t a•.F.�y, Pursuant to IC 6-1.1-5.5
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4, =;:: PRIVACY NOTICE:The telephone numbers and Social Security numbers of the parties on this form are confidential
7iria according to IC 6-1.1-5.5-3.Do NOT place personally identifiable information(e.g.consulate numbers,passport numbers;
government ID numbers,etc.)on this form as It may become publicly available.
NOTE:All questions must be answered to the best of the Individual's ability.If the question does not apply,write"NIA"In the
space provided.If the information requested is unknown,leave the space provided blank.Failure to provide a response for the
italicized fields shall not result in the rejection of the underlying conveyance document by local officials.
INSTRUCTIONS:For additional information on how to complete this form,see the Sales Disclosure Form Instructions.
1 PART 1 -To be completed by BUYER/GRANTEE and SELLER/GRANTOR
A. PROPERTY TRANSFERRED — Must be conveyed on a single conveyance document(Additional contiguous
properties can be listed on Page 5.)
1.Parcel Number or Tax Check all boxes 5.Complete Address of Properly 6.Complete Tax Billing Address(if
Identification Number applicable to parcel. I different from property address)
A.)26-14-18 303-001.142-007 El 2 Split 635'West Division Street 635 West Division Street
Oakland City, IN 47660 Oakland City , IN 47660
❑X 3.Land
0 4.Improvement
7.Legal Description of Parcel:PT SW 18 2 8 .25 AC, Gibson County