Homestead_EsareyINDIANA SALES DISCLOSURE FORM SDF ID: Pa @ 2
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Karen Harbison VP
�%epareroflheSaletD"utlotureFo(m TiLe
803 E State Rd 68 The Elberfeld Siate Bank
Address (Number and Strm[f
Ciry, 5[are, andLPCode Telephane Nvm6er Email
^E� SEL�ER S GRANTOR S �-�—� - �- �� �� �:-.-� � � �' � _ �=--}�:`'
-� Amv C Roos fortnedv Amv C GreubPl. now known as Amv C Adams
Sefler 1� Name ar appears w ronveyvnre dacvmen[ SMler 2- A'ome as appears w cwveyonte docummt
7462 E 1025 S
Add�ess (Number and5trre[J Addr¢s (Nvmber and Strtt[)
Ha�6ctadt IN 47640
Tele honeh'umber E-mail Tele honeNUm6er E-mail
Under penal[ies of perjury, t hereby certify that [his Sales Disclosure, to [he bes[ of my knowledge and belief, is true, torrec[
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Proper[y Sales Disclosure Act".
� Sig ureo(Seller SignaN�eofSeller
Amv r Rnnc f-0reuhel Adams 04042012
PnnledNameo Sel/er SipnDa[e MM DD nn ameo e� SipnDate(MM/�D
� ' , 5 GRANT �'APP;LICATIONFOR'PROPER ; AX�DEDUGTIONS=�iD&NTIFIYIA 11T6MSsTHATAPECY��' � "°'^�
B an W Esare Pamela M Esare
o1�Na nronvryvncedorvmmt � easa➢pmrsonronvryanredocvmen[
t ve oo d 12035 Overloak Rd
Addren (Num4er ond5veetJ Addr� (Nvm6er and5trretJ
�Enqlish IN 47118 Enalish IN 47118
mail Tele honeNUmber E-mail
THE SALFS DISCLOSIIRE FORM MAY 8E USED TO APPLI' FOR CFRTAIY DEDUCfIONS FOR THIS PROPE THAT APPLY.
YES 60 COtiDITION YFS NO CO\DITION
0 ❑ 1.1Ni11 [his property be the buyer's primary � ❑ 3. Homestea
residence? Provide complete address of prima , Ititg-System
residence, induding county:
'idfi� F 7025 S ❑ � 5. Wind Power Device
Address(Numbvand5tree[) ❑ � 6. Hydroelectric Power Device
Haubstadt IN 47639 Gibson � � 7.GeothermalEnergy Heahng/Cooling Device
Ciry.Sm[eZIPCode Counry
0 ❑ 2. Does [he buyer have a homes[ead in Indiana to be � � $• �s this property a residentlal rental property?
vacated for this residence? If yes, provide ❑ � 9. Would you like to receive tax statements for this
complete address of residence being vacated, property via e-mail? (Provide contoct in%rmation
induding county: 6elow. Please see ins[ructions for more informadon.
12035 Overlook Rd Not availa6le in a/llf ounties)
Address(Num6erandSVeetJ � _/ ^' 7I . /�(/ .}
Enalish IN 477 78 � v i'� %40 - 04/. ��� �°s
Ciry, Smre ZIP Code Covnry
Pn'marypmperryownerrontacaname E-mail
Under penalties of perjury, I hereby certify [hat this Sales Disclosure, [o the bes[ of my knowledge and belief, is true, torrec[
and complete as required by law, and is prepared in accordance with IC 6d.1-5.5, "Real Property Sales Disclosure Act". (No[e:
Spouse information, Social5ecurity and Driver's License/Other numbers are not necessary if no Homestead Deduttion is
�bein filed.) �
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LastSdigitsofBu}rer]Driver's Sm[e LastSDigittaj5odalSecuntyNumber LastSdigiao/BuyerZ/SpouseDriver's State Las[SDigiGra(Social5ecunry
License/ID/OlherNum6er Num6er License/ID/OtherNumber