HomeMy WebLinkAboutHomestead_Reinhart (5)INDI.�NA SALES DISCLOSURE FO
D. PREPARER'
. `
Karen Harbison �
Preparer o([he Salu Di�closure Form
�
.03 E State Rd Hwv �8
Address (A'umber and Sveeq�-
The Elberfeld Siate Bank
Company
Haubstadt IN 47639
Ciry, Sm[e, and ZfP Code Telephone Number E�mail
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Address (Num6er and Svee[)
KPfOPfCVIIIP ur, 979A4
Ciry, Smte, and ZIPCade
DPway EigPnP Robeson
Sefler 2- Nam<as appears on ronvrynnre dotument
7RFi4 Haw MPa�lowc Dr
Address (NUmber and Svee[)
KamPrcvillP NC 27284
Ciry, Smre. and ZIPCOde '
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Under penalties of perjury, I hereby certify that [his Sales Disclosure, [o the bes[ of my knowledge and belie(, is true, correct
�i-p--l�e-t�e� as required b}' law and is prepared in accordance with IC 6-1.1-S.S, "Real Property Sales Disdosure Act".
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iynamreo/Seller T• ' � Signam�e eller
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dotument
document
8776 S 225 E 8716 S 5225 E
Address (1lumberanC Svee[J dddrrss (A'umbe� and 5[ree[)
Ft Brench IN 47648 Ft Brach IN 47648
i91 Sm[e. and ZIPCade Ciry. Sm[e, and Z!P Code
Telenhone,YUmber E-mail Tele honeNumber E-mail
THE SALES DISCLOSURE FORAt MAY BE IISEU TO APPL4' FOR CERTAIti DEDUCf IONS POR THIS PROPERT'. IDENTIFY ALL OF Tf105E TIIAT APPLI'.
rrs n�o co:cmnun
�✓ � 1. 4Vi11 this property be [he biryer's primary 1
residence? Provide complete address of primary
residence, induding county:
?01 Cn ih Fa�NiPw St
Addres (Nvmber and Svae)
Fi Branch. IN 47648 Gibson
c.y, s�a«z�r coe� co��ry
� Q 2. Does the buyer have a homestead in Indiana to be
vacated forthis residence? Ifyes, provide
comple[e address of residence being vacated,
including county:
Address (h'umher and Svee[)
Ciry, Swfe Z!P Code Caunry
3 H�
4. Solar Energy Hea[ing/Cooling System
� Q 5. Wind Power Device
� Q✓ 6. Hydroelectric Power Device
❑ ❑✓ 7. Geo[hermal Energy Hea[ing/Cooling Device
� Q 8. Is this property a residen[ial rental property?
� �✓ 9. Would you like m receive tax statements for this
property via e-mail? (Provide contoct information
below. Please see ins[ructions for more informatfan.
Not available in all counfies.)
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Pnmarvomoer[VOwnerronmaname E-mail
Under penal[ies of perjur}', 1 hereby cer[ify [hat this Sales Disclosure, [o [he bes[ of my knowledge and belief, is [rue, correct
and complete as required by law, and is prepared in accordance wi[h IC 6-11-5.5, "Real Property Sales Disclosure Ac[". (No[e:
Spouse information, Social Security and Driver's License/Other number are not necessary if no Homes[ead Deductlon is
being 1 d.) _n /"•' l� �`V� `-' `- +� ll�' 1�� �
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Cicense/lD/Other A'um6er
$ign Dale (MM/�0/YYYYf
Number
I nr' K Rainhnrt 03/17ii071
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Number License/lD/OfherNumber