Homestead_Gilles (3):�. .
INDIANA SALES DISCLOSURE FORM SDF ID: Pa e 2
D.PREPARER
Karen Harbison VP
Preporero(NeSalaDittl�reForm Titlt
803 E State Rd 68 The Elbedeld State Bank
Addrus(NvmberandStreeQ
E. SELLER S GRANTOR S
Matthew W Gillec RrhPCra K GillPs
SNler I- Nvme as appears on ronveyvnce daaument Sd,ie/r2 - N,a/me as cappears on conveyance documten[" ../.
tA42 E SiPrta Dr `Y�a"T d ��f 5/ ,ee C
Addren(h'umberondSVcelJ Addrus(NumberandStrre[J
HaubstadtlN47639 J-�E[.[-�bS-%GL� / 9J �ki(o3�1
Under penalties of perjury, I hereby cer[ify tha[ this Sales Discicsure, [o [he best cf :ny knowledge and belief, is [rue, correct
and complete as required b law, and is prepared in accordance witnh IC 6•1.1-5.5, "Real Property Sales Disclosure Ac[".
"��/� 6C 0_�a?�! n G��,��/%/ /�-/o�t��0
Signamre o(Selier /^1 ,/� �Signamre o/Selfer
MatthPw W Gilles '// �0�/`� Re6ecca K Gilles
e ameo e e Si n0ate .uM no Pnn[edNamea Sel/er Si nDau XM D
F. BUYER S GRANTEE S- PPLICATION FOR PROPERTY TAX DEDUCTIONS- IDENTIFY ALL ITEMS THAT APPLY
Mait ew W Gille
erl�Nameasappearso nttdxument Buyer2-Nameotappearsontonveyunredocumen[
1832 E Sierra Dr
Addrecs(NumberandSVeeQ Address(A'umberand5treet)
� Haubstadt IN 47639
Tel E-mail
TNESALESDISCLOSUREfORMhf.1YBEUSEDTOAPPLYFORCERTAI\UEDURIO, TNISPROPERTV.IUEMIFYALLOiTH TTPPLY.
1'FS AO C08DITIOV FS KO COYDITION
Q✓ � 1. Will [his property be [he buyer's prima Q✓ ❑ 3. Homestead
residence? Provide complete address of imary , nergy Heating/Cooling System
residence, including county:
18�� F G'Prra Dr ❑ Q 5. Wind Po�ver Device
Add�ecs(A'umbe�andSVreQ ❑ Q 6. Hydroelectric Power Device
Haubstadt IN 47639 � Q 7. Geothermal Energy Hea[ing/Cooling Devite
Ciry, Sm[e 21P tode Counry
� Q 2. Does �he buyer have a homestead in Indiana to be ❑ ✓❑ 8. Is [his proper[y a residen[ial rental property?
vacared for tnis residence? IFyes, provide ❑ �✓J y� �'t%ould you like to receive wx statements for this
complete address of residence being vacated, property via e-mail? (Provide rontact informotion
including county: below. Please see instructions for more information.
Not available in all rounties.)
Address (Number and Street)
-ol3-,iG - /o� - o a� 4�9- oa
Ciry.SwteZlPCode Counry
Primaryproperryowne�conmctname E-mail
Under penaities of perjury, 1 hereby certify [hat this Sales Disdosure, to [he bes[ of my knowledge and belief, is true, correc[
and comple[e as required by law, and is prepared in accordance wi[h IC 6-11-5.5, "Real Property Sales Disclosure Ac[". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homes[ead Deduction is
being filed.)
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�� SignamreofBuyeA SignamreofBuyer2/Spouse
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Number License/!D/OtherNumber