HomeMy WebLinkAboutHomestead_BurkeINDIANA SALES DISCLOSURE FORM SDF ID SDO ID 711636
Page 2
D:. PREP ARE
Shelly MCI) Kiel Settlement Coordinator
Prparerof the Sales Disclosure Form ride
BI'Ma, D, Secured Lending Services
(&,.
(N um;be,and Street) company
Pittsburgh, PA 15205-
E-mail
IE.-SELLER(S)/GP�ANTOR(S),!'.-"� -4, �01k Y Jr
z:
HSBC Mortgage Services, Inc
Seller I - Name as appears an conveyance document
Seller 2 - Name as appears on conveyance document
931 Corporate Center Drive
Address (Number amscrvvi)
Address (Number and Street)
Pomona, CA 91768-
City State, and ZIP Code
City, State, and ZIP Code
E-mail
I Telep hone Number E -mail
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act".
Signature olseller Signature efSeller
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T.-B -4,z ;;,)-:7�
6�YEF�(S)�/GtN5TEE(S)�.-,APPLItATION;F.OR,.P.RO;�'ERTY-,,TAXIE DUCTIONS7�IDE�N"TIFY,,IALL�,ITEMS�THAT.-'APPLY;
Greg A Burke
Buyer I - Name us appears m, conveyance document
Buyer 2 - Name as appears on conveyance document
104 N 3rd St
Address (Number and Street)
Address (Number and Street)
Francisco, IN 47649-
SewcondZIPCnde
cirrysnow, and ZIP Code
E-mail I
Telephone Number E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION YES NO CONDITION
nx ❑ 1. Will this property be the buyer's primary
E ❑ 3. Homestead
residence? Provide complete address of primary
❑ FL] 4. Solar Energy Heating/Cooling System
residence, including county:
[] FL] 5. Wind Power Device
104 N 3RD ST
❑ FL] 6. Hydroelectric Power Device
Address (Number and Street)
Francisco, IN 47649 GIBSON
E] E] 7. Geothermal Energy Heating/Cooling Device
E] FL] 8. Is this property a residential rental property?
City, State ZIP Code County
❑ ;E] 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
❑ E) 9• Would you like to receive tax statements for this
complete address of residence being vacated,
property via e-mail? (Provide contact information
including county:
below. Please see instructions for more information.
Not available in all counties.)
Address (Number and Street)
City, State ZIP Code County
Primaryproperty, owner contact name E-mail
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance with IC 6-1.1-5.5, "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.)
Signature of Signature of Buye,21SPouse
9ft r4 )
sign Dow (mmlaiilrryn Printed Legal Name of Buyer 21spouse Sq. DOW (MMIDDIYYYY)
IN
Lost 1 Driver's State Last 5 Digits ofSocial Security Number Last 5 digits, of Buyer 2 /Spouse Driver's State Last 5 Digits ofSocial Security
License /ID /Other Number I Number LicerselID10ther-Number