Homestead_Bitter..
'' INDIANASALES
Karen Harbison
, R'eparero(the5o/a0trdosureFo�m
2 '
� 803 E State Rd 68 Elberfeld Siate Bank
Addr¢s(NumberandSVre[) Campany
Haubsiadt IN 47639
E-mail
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Seller 1� N�ame af apPears on ronvrymce dorument Sellei 2- h'ame as oppears on conveyance docvment
��\`Q.V�-rS��00� ��, 75f17WR(1(1G
.iddress(A'umberand5q1 ee[J �,` ' 1 Address(Num6erandSVretJ
�VQ� S �i 1`\ � Z I�i �—t�� �� Fi Branch. IN 47648
Ciry, Smtq ond L➢COde Ciry, Smtq ond ZIPCade
Under penalties of perjury, t hereby certify that [his Sales Disclosure, to e est of my Fr
and complete as required by law, and is prepared in accordance with IC - 1-S.S, "Real
x �,� c� C��� I-�-----
SignamreoJSe r Signa2reof5efler
Addras
[iry. state,
FORhi MAY BE USED TO APPLY FOR CERTdI\ OEDUCTIONS FOR THIS
JQ � 1. lNill this proper[y be the buyer's primary
residence? Provide complete address of primary
residence, induding county:
Addren (h'umber and Street)
Ft Branch. IN 47648
[iry.SmreZIPCode [ounry
� J❑ 2. Does the buyer have a homes[ead in Indiana [o be
vacated for this residence? If yes, provide
complete address of residence being vacated,
including count}�:
Addras (Number and Svee[)
Ci[v.SmteZIPCaEe Counry.
as appmrs on ronveyante dxument
Add�ess (h'umber and Strret)
Ciry, Smu,
THOSETHATAPPLV.
[rue, torrect
ire Ac[".
� ❑J ❑ 3. Homes[ead
,/ 4. Solar Energy Hea[ing/Cooling System
� Q 5. Wind Power Device
� ❑J 6. Hydroelectric Power Device
� ❑J 7. Geothermal Energy Heating/Cooling Device
� QJ 8. Is [his property a residen[ial ren[al property?
� Q 9. 4Vould you like to receive [ae s[atemen[s for [his
property via e-mail? (Provide contoct informotion
belo�v. Please see instructions for more in�ormation.
Not available in ll munties.J
�/ -/� ��-� -a�a. o3s-a��
name
E-mail
Under penal[i of perjury, 1 hereby cer[ify [ha[ this Sales Disclosure, [o the bes[ of my knowledge and belief, is [rue, correct
and comple[ arrequired by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". (No[e:
Spouse info mation, Social Security a ver's License/O[her numbers are no[ necessary if no Homes[ead Deduction is
beingfiled.� � �i/7�
sy�a"��e o/e�yen L Sig�omre o(Buyer2/SVOUSe
h r a n /�/��� �
PnnedLegalNameofBvyerl SignDate(MM/00/1YY17 PnntedLegalNamea(Buye�1/Spouse SignDare(XM/o0/Ym�
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LastSdigitsoJBuyer]Driveis State Las[SDigi6o/SocialSe[untyA'um6er Las[SdigiaofBuyer2/SpauseDnveri Smte Last50igitro�SotialSeruriry
License/ID/OtherNum6er Number License/ID/O[herNumber