HomeMy WebLinkAboutHomestead_WaymanINDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
D.PREPARER '
Karen Harbison VP
Prepare�ofthe Salef Di.ulosvre Form Title
803 E State Rd 68 The Elberfeld State Bank
Addreu (NUmber and SPeet) Company
HaubstadLlN 47639
E-moil
E. SELLER S GRANTOR S �
Patncia J Lindauer Susan A Lindauer
Seller 1- Name as appmrs on conveyvnre dacumen[ Seller? � Name os appears m mnveyanre document
107 Woodward Dr 404 E Strain St
Address (Number and SveeQ Addrecs (h'umber and Sveetf
Evansville IN 47712 Ft Branch IN 47648
E-mail
Under nal[ies of perjury, 1 hereby certify that this Sales Disdosure, to [he best of my knowledge and belief, is true, correc[
and plete uired y law, and is prepared in accordance wi[h IC 6-11-5.5, "ARe Pro�pe�r[y� S�a�le"s D�isdosure Act".
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Signamre of5e ' �" Signamre o(Seller
Patrinia .I I inAanPr 02I15I2011 Susan A Lindauer 02/15/2071
Pnn¢ Si n Dare MM 00 PnntedName o Se/ler Sion Date MH oD
. UYERS GRANTEES APPLICATIONFORPROPERTYTAXDEDUCTIONS-IDENTIFYALLITEMSTHATAPPLY
C r B Wa man
.., vypeorsonconveyan[edocvment Buyer7-A'ameasappearsonmmryanredo[vmen[
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Addreu (NVm6er and StreelJ Address (Num6er ond Svre[J
�FtBranch IN 47648 812-664-
E�mail Tefe honeNumber E-mail
TNE SALES DISCLOSURE FORM MAY BE USED TO APPLV FOR CERTAIY DEDUCfIONS FOR THIS PROPERTV. I�ENTIFY' ALL OF THOSE TNAT APPLY.
YFS RO COAOITIOY YES IOV
0✓ � 1. Will this property be the buyer's primary Q ❑ 3. Homes d
residence? Provide complete address of prim , olar Energy Heating/Cooling System
residence, including county:
109 F Fvan� Ct ❑ Q 5. Wind Power Device
Address(h'umberand5veet) ❑ ❑✓ o. Hydroelectric Power Devite
Fi Branch IN 47648 Gibson � Q 7, Geothermal Energy Heating/Cooling Device
Ciry. Sm�e Z(PCOde Caunry
� �✓ 2. Does the buyer have a homestead in Indiana to be � ❑� $� �s this property a residential ren[al property?
vacated for this residence? If yes, provide ❑ ❑✓ 9� Would you like to receive tax statements for [his
complete address of residence being vacated, property via e-mail? (Provide rontact in/'orma�ion
including county: below. Please see instructions for more in%rma�ion.
Not availa e in all counties.J
Address(Numberand5veetJ /)�'/ n �/���0. �.f% Id �S�
[/I O }f� � e!(O v03
Ciry. Smce ZIPCode Caunry
Pnmarypropertyownerronmttname E-mail
Under penal[ies of perjury, 1 hereby certify [ha[ [his Sales Disclosure, to the bes[ of my knowledge and belief, is true, correc[
and comple[e as required by law, and is prepared in accordance with IC 641-5.5, "Real Property Sales Disclosure Ac[". (Note:
Spouse informa[ion, Social Security and Driver's License/O[her numbers are no[ necessary if no Homestead Deduc[ion is
being filed.) � �
y � -�/� G/a�r-�—
/ �/' Sign o(Buyerl Signomre o(Buyer2/Spouse
1�'ar y R Wavm�n 02/15l?011
LastSdigicsofBuyerlOriver"s Staie LastSDigi[so(Social5ecunryNum6er Los[Sdigiao%Buyer2/SpauseDriver's Smte LostSD{qicso%SocialSecunry
License/ID/OrherNum6er Number Lirense/ID/OlherNumber