HomeMy WebLinkAboutHomestead_StaplesINDIANA SALES
Preparero(rhe Salu Disdos�re Form
7820 Eaqte Crest Blvd Ste 201
ress(A'umberand5[m[)
nsville IN 47715
lity, Smre, and ZIP Code
Aamn r Wibhat'hpr
Seller 1� Nome as appears on wnvevance docvment
1'IR S Weber Dr
Addrea (h'umber and Strcet)
Ha hstadt, IN 47639
Cig•. Sta[e, and ZIP Code
Closinq Coordinator
r�e
Regional Title Services
E-mail
Seller 2- Name as appmrs an ronveyanre dacumen[
Add,es (Number and StreetJ
Ciry. Smte, and ZIP Code
E-mail
Under penalties of per�ury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
an omplete a r ired by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
1 �
Signamreof5eller Signa[urea(Seller
1- M1'ome a�on conveyanre dacument
Haubstadt IN 47639
�Srnle, and ZlP lode
Buyer 2- Nome as oppmrson ronveyanre dommen[
and5[reet)
Ciry, Srnre, and ZIP Lode
THE SALFS DISCLOSURE FORM M1L1Y BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
Q� 1. Will [his property be the buyer's primary
residence? Provide complete address of �
residence, including county:
5M F Strain St
Addres (Nu mber and Slree[)
Ft.Branch IN 47648
Ciry. Smte ZIP Code Counry
� Q 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
complete address of residence being vacated,
including county:
Addres (Number arM S[ree[J
Ciry, Smte ZIV Cade Counry
� ❑
❑ �
❑ ❑✓
3. Homes[ead
Sys[em
5. Wind Power Device
6. Hydroelectric Power Device
7. Geothermal Energy Heating/Cooling Device
8. Is this property a residen[ial renWl property?
9. Would you like [o receive [a�c statemen[s for this
property via e-mail? (Provide contoct injormation
beloiv. Please see instructions for more information.
Not available in all counties.)
o�lo- / I/dn a�0.�- Q�..�/�i�- Oo1 �
owner mnrntt nome
E moil
Under penaltles of perjury, l hereby certify that this Sales Disclosure, [o the best of my knowledge and belief, is true, correc[
and complete as required by law, and is prepared in accordance with IC 6-1.1•S.S, "Real Property Sales Disclosure Act". (Note:
Spouse informadon, Social Security and Drive�'s License/Other numbers are not necessary if no Homestead Deducdon is
Driver's Smre LastSDigi[sof5ocio15ecuriryNumber
Lirense//D/Other Number
Sjgnatvre o/Buyer2/Spovu
Legal Name o(BuyerT/Spouse
Last 5 digiu a�Buyerl/Spouse Dnver's Smte
Num6er License/ID/O[herNumber
5{qn Dafe (MM/DD/YYYY)
Last S Digi[s oj5ocial5ecuriry