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iNDIANA SALES DISCLOSURE FORM SDF ID: Fa e Z
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Karen Harbison VP
�Preparero/lheSalaD'¢dosureFo�m Title
803 E State Rd 68 Elberfeld State Bank
Address (Num6er and Stree[f ��+�+
E�SECIiER S ,GRANTOR S �'�m��s.�'_��''-z�.:���-���� '�.����� �'-=�-��s _ '�^.�—,-�---�`"�_��'�,
William J TPnbarge
Seller 1� Nome ae appears on ronveynna dxument Shcer 2- Name as appwrs m mmryv^ce daumm[
1147Q S SO W
Addrers (h'umWi and Suee[J Address (Number ond StrretJ
Hai hctadt IN 476't9
Te/e honeNumber E�mail
Under penalties of perjury, I hereby certify tha[ this Sales Distlosure, to the best of my knowledge and belief, is [rue, correct
and comple[e as rgquired b law,�d is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Ac[".
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SignaNreo(Shcer Signao�reoJSeller
Wll'am I Tenbarga 01173/2012
PnnlCdNameo(Shcer Si nDa[e MM/00 PnntedNameo Seller Si nDole MM/OD
=F:<BUY ' RANTEE S '�AP.PIiICAT10NiFOR?P,ROP.ER7iYsTAX+DEDUC°TIONS�',IDENTIFYAIili�ITEMSiTHAT ARPliYr,-""a b� =���'�s
Adam J Men all R Men
Buyvi�Na apPearsomm�veyon�edacvmenc Buya2-Nameatap cmvryanadorumrn[
665 W 1200 $ 665 W 1200 $
Add�ess (A'umberand Stree[J Addren (Number and Stree[)
THHSALFSDISCLOSUREFORMMAYBEUSEDTOAPPLVFORCERTAINDEOOCfi0N5FORTHI . I A THATAPPLY.
YFS NO CONDITIOY \O CONDRIOY
Q ❑ 1. Will this property be the buyer's primary Q ❑ 3. Homeste
residence? Provide complete address of pri , o ar Energy Heating/Cooling System
residence, induding county: � Q 5. Wind Power Device �
� td7q C SO W
AQdras(NumbcrandStreet) . ❑ Q b. Hydroelectric Power Device
Hauostadt iN 47039 _ Gioson �� Q 7. Geothermal Energy Heatlng/Cooling Device
Ciry.Sm¢ZIPCode Counry
❑ � 2. Does the buyer have a homes[ead in Indiana to be � 0 8� �s this property a residential rental property?
vacated for this residence? If yes, provide ❑ � 9• Would you like [o receive tax sta[ements for Chis
mmple[e address of residence being vacated, property via e-mail? (Provide confact information
including county: below. Please see ins[ructions formore informatron.
Not availa6le in all coun[ies.)
Address (Nvm6er and Svee[)
c?� - z z_,r� -,�oo cb/ 3.3 oa �!
[iry, Smte ZIPCOde Covnry
Vnmaryproperryownermnm[tname E'-mail
Under penalties of perjury, 1 hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and tomplete as required by law, and is prepared in accordance with IC 6-11-5.5, "Real Proper[y Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
bem filed. � j�i2� //A ����
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9gna[�� Signamre oJBuyu2/Spouse �
IJ�ndell R AAepy O1/�.ii2n�2