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1\'DI.AVAS.ILESDISCLOSUREFORU SDPID SDOID 759260 Page?
D.PR�PARER
Kim Miller Escrow Closer
�Preporer afNe Safes Oudosur'e Fonn Title
331 Franklin St Title Center of Indiana
Address(NUm6erand5neetJ
� E. SELCER S GRANTOR S
Donald F Housholder Evelyn A Housholder
Seller ]- Name as appmrs on mm�eynnae daumenl Sellrr? - Name as appears m ronveyanre dxument
1922 Sierta Dr 1922 Sierta Dr
Address(NUmberand5treer) Addrcss(Numberand5treetJ
Haubstadt, IN 4763& Haubstadt, IN 47639-
Under penalties o( perjury, I hereby certify that this Sales Disclosure, to the bes[ of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance with IC 6-11-5.5, "Real Property Sales Disdosure AcP'.
��on,� �,ii��-G'�oe� �,,.._ ,f� l,!�L/,.�'—�-
9gnamreo(Seller Signamrea Seller ���
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. BUYER S GRANT E S- APPLICATION FOR PROPERTY TAX IONS- IDE LL ITEMS THAT APPLY
ian M Frederickson Kimberly A Babaian
BuyrN-' aappeursanronrryanredocvment . . ,�mm�rynncrdorumen�
722 S West St 722 S West St
AEdrea(NUm6erand5treetJ Addrrs(h'um6e�and5rceet)
Oakland City, IN 47660- Oakland City, IN 47660-
YFS NO CO\OITIOV YES
Q � 1. �Vill this property be the buyer's primary x � 3. Homestead
residence? Provide complete address of primary 4. Solar Energy Heatin;/Cooling System
residence, including county:
1922 SIERRADR ❑ Q S. Wind PoWer Device
ndd.��rv�mbc�o�esur�g ❑ Q 6. Hydroelectric Power Device
HaubstadL IN 47639 GIBSON � � 7, Geothermal Energy Heating/Cooling Devite
Ciry, Sm[e ZIPCode Counry
��,��1 /�2. Does the buyer have a homestead in Indiana to be � 0 e� Is this properry a residen[ial rental property?
�'yp�� vacated for this residence? If yes, provide ❑ 0 9. Would you like to receive tax statements for this
mmplete address oF residence being vacated, properry via e-mail? (Provide contnct in%rmation
induding counry: Gelow. Please see instructions(or more in%rmatian.
% Z2. 5. l.�C.ST S 1. /� Not availnble in all rounties.)
Addrealh'umbernd5reet) 1�'�_I�_�"V_^^'.�/ 1��
faaktar,r� � +.� ��n1 y7l�con ����Sen a UV '�4
Ciry, Smte ZIPCode lounry
Rimaryproperry owner ronmct namr E'�mail
Under penal[ies of perjury, I hereby certify that this Sales Disclosure, to [he best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance with IC 6-11-5.5, "Real Property Sales Disclosure Act". (NOte:
Spouse in rmation, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
being .) � p
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ignaNreo( yrrl �Sg�reofBuyer7/Spoum
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