Homestead_Lamey (21)INDIANA SALES DISCLOSURE FORM SDF ID: •Pa e 2
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KAREN HARBISON VP '
�Preparera/"Ne Sala DS[losure Farm TiUe
803 E STATE RD 68 ELBERFELD STATE BANK
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Under penal[ies of perjury, I hereby certify [hat [his Sales Disclosure, [o the best of my knowledge and belief, is true, correc[
and c mple[e as required by law, and is prepared in accordance wi[h IC 6Q.1-S.S, "Real Property Sales Disclosure Ac[".
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�Haubstadi IN 47639
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THESTLFSDISdOSUREi0M1MAYBEUSEDTOAPPLYFORCFRTAI\OEDURIOYSiORTHI5PR0 OFTHOSETHATAPPLY.
VES �0 C09DRI06' YES \0 CO%DRIOY
� ❑ 1. Will this property be the buyer's primary Q ❑ 3. Homes[ead
residence? Provide wmplete address of primary , olar Energy Hea[ing/Cooling Sys[em
residence, including county: � � S. Wind Power Device
Addren(Nutmberand5treetJ ❑ � 6. Hydroelectric Power Device
Haubstadt IN 47639 Gibson � � 7, Geo[hermal Energy Heating/Cooling Device
Ciry. Smce ZIP Code lounry
❑ Q 2. Does the buyer have a homestead in Indiana to be � � g� �s [his property a residential rental proper[y?
vacated for this residence? If yes, provide ❑ � 9. Would you like to receive tas statements for this
complete address of residence being vacated, property via e-mail? (Provide con[act informatlon
including county: below. Please see instructions(or more information.
Not available in all caunties.)
Addrezs(NumberondSveeQ
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City.Sm[eZIPCade Counry E-mail
Pnmary properry owner ronrnc! name
Under penalties of perjury, t hereby certify that this Sales Disdosure, 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 Disdosure Act". (Note:
Spouse information, Social Security and Driver's License/O[her numbers are not necessary if no Homestead Deduction is
being filed.) ^
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License/ID/OtherNum6er Number Licerue/(D/OrherNumber