Homestead_Barbert
ISDIA�A SALES DISCUO RE FORU
hynrer o/[he Scln D'udosvre Farm
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SDF ID $DO ID 464465 Page 2
OKce Manager
Title
Broadway Tlle, Inc.
com��y
Philip Ward Miller � Regina Lynn Miller
Seller ]� Kame asappears a� mnvepun�e dorumen� Set�er3 � Nume ns uppean un i�onvewnae darument
2776 N. State Rd. 65 ��� 2776 N. State Rd. 65
AAAress(Numbermd5veer) AEd.rss(A'umbe�and5trcet)
Patoka, IN 4766G Patof�a, IN 4766E
Ciq�, Smte,
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Under,P��nalties of perjurv hereby certify [hat this Sales Disdosure, to the best o(my knowledge and belief, is true, correct
and p6ffipJetQas�ty�l�ire�}'�i�aw, and is prepared in accordante with}�11-5.5, "Real Property S�yDisdosure Act'.
Namld R Barber Jr.
Buye� I� Name as oppmrs on rnnveynnre dotumen:
FY ALL [TEMS��THAT APPCY
Judith H. Barber 1
Buyer2�Nameusnp� mm�vevnnacdocumenl
213 1 st Ave. e.
dddrees(h'umbe�andStreet) Addras(Numberond5treeQ
Haubstadt, IN 47639- Haubstadt, IN 47639-
Ciry.Smre, and ZIPCaRe
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DISCLOSIIRE FORN MAY BE USED TO APPLY FOR CERTAI.Y DEDUCTIOYS {'OP THIS PROPERTY. IDENfIFS' ALL OF TNOSE THAT APPLY.
x0 ❑ 1. Will this property be the buyer's primary
residence? Provide complete address of primary
residence, induding county:
2776 N STATE RD. 65
AAdress @'um.ber ond Shx[)
Patoka, IN 47666 GIBSON
Ciry.Au[eZIPCode Collnry
�� 2. Does the buyer have a homestead in Indiana [o be
vacated for this residence? If yes, provide
complete address of residence being vacated,
induding county:
Addrea (NUm6rr ar.d SureQ
liry, Sm¢ ZIP Cade Covnry
� ❑ 3. Homestead > .
���STEfi a mg/CoolingSystem
� Q 5. 6Vind Power Device
� Q 6. Hydroelectric Power Device
� Q 7. Geuthermal Energy Heatlng/Cooling Device�
� Q 8. Is this proper[y a resideniial rental proper[y?
� Q 9. 6Vould you like [o receive tax statements for this
properry via e-mail? (Provide contnctinformation
below. Please see instructions/'or more in/'ormation.
No[ available in all caunties.J
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PnmarvvmoerNO�mercenmctnume E-mail
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Under penalties of perjury, 1 hereby certify tha[ [his Sales Disdosure, to [he bes[ o(my knowledge and belief, is true, correct
and compiete as required by law, and is prepared in accordance with IC 6-11•5.5, "Real Property Sales Disclosure Act". (Note:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is
being filed.)
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