Homestead_Williams (12)1\DIAY,� S.�L DISCLOSURE FORU SDF ID SDO ID 464908 Page 1
�D.PREPARER �
411chelle Ha nes Closing Agent
PrepareraJNe Sala D'udosvre Form iltle
501 Main Street, Ste 101 Bosse Title Company
Addrcs(NumbrrandSmrtJ fnmyuny
Evansville, IN 4170&
Email
E.SELLER 5 GRANTOR S � � � � �
BriiNey C Dant
Seller I� Name at apptars on com�e�ante da'ummt Sella 2- Name as appeun om m�veyvnce da'umm�
1603 E Lake Road
Addrtzs (NUmber and Streery Addre.cs (Num6er ond SReet)
Princeton, IN 47670.
Ciry, Smre, and ZIPCOde Ciry, Sm[g and ZfPCode ,
Tde haneh'umM E-moil Tde froxA'umber E-mail
Under penalties of perjury, l hereby certify that this Sales Disdosure, to the bes[ of my knowledge and belie(, is true, correct
a comple[e as required by law, and is prepared in acwrdance wi[h IC 6-1.1-5.5, "Real Proper[y Sales Disclosure Act".
e.
�qna of5 ler Sgnamreo/Seller
1 I a0(D
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. UYER S GRANTEE S-.APPLICATION FOR PROPERTY TAX DEDUCTtO - i L ITEMS�THATAPPI,Y �
Clint E Williams � resa Williams
��__. .... vnce ocument evyer2-Nameosappearsonmmeynncedavment
5073 Bosvrell Roatl 5073 Boswell Road
Add.eu(NUmberandSo-eee) Addres(Sumberand5veec)
6vrensboro, KY 42307- Owensboro, KY 42301-
Ciry. Smu. and ZIPCOde Ci%Sma. andZlPCade
Tele honeNum6er P�moil Tele haneNUm6er E�mail
THE SALFS DISCLOSIIRE FORM MAY BE USED TO APPLY FOR CERTAIN DEDOCfIOVS FOR TNIS PROPENTY. IDETTIiY ALL OF TNOSE TNdT dPPLY.
1'FS NO CONOITION 1'ES NO [ONDITIOY
x❑ ❑ 1. Will this property be the buyer's primary ❑x ❑ 3. Homestead —' �--�
residence? Provide complete address of primary � � 4, Solar Energy Heating/Cooling System -
residence,includingrounty: � �
1603 E LAKE ROAD 5. Wind Power Device
naa.�@'um6erendSVretJ ❑ Q 6. Hydroelectric Power Device
Princeton, IN a7670 GiBSON � � 7. Geothermal Energy Heating/Cooling Device
Ciry,SmleZlPCode Caunry
�� 2. Does the huyer have a homestead in Indiana to he � 0 8� Is this property a residen[ial renWl property?
vacated for this residence? If yes, provide ❑ � 9� �Nould you like to receive tax statements for [his
comple[e address of residence heing vacated, property via e-mail? (Provide contoct in%rmation
inciuding counry: below. Please seelnstructians/or mare informaaon.
Not available in a!! counties.)
Address (A'um6er and5[reetJ
� -ia-o 9- �o�-an. � �-oa �
Ciry.StamZlPCode Comty.
Pnmaryproperryownerronmc[name Email
Under penal[ies ofperjury, 1 hereby certify that [his Sales Disclosure, to [he best of my knowledge and belief, is true, cor�ect
and comple[e as required by law, and is prepared in atcordance with IC 6d.1•5.5, "Real Property Sales Disclosure Act". (No[e:
Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deducdon is
being filed.) �\
CL',IQ.,Ga�
Sigq�lurea(Buyed SianomrtofBuyei2/5 use
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Social5ecunryMumber LastSdigiuo%Buyer7/SpouseDnver's Smre Cos[SDigi[sofSxialSecunry
Lirense/10/OlherNwnbcr Numbcr Licensc/ID/O[herNumber •