HomeMy WebLinkAboutHomestead_Jenkins (6)DISCLOSURE FORAf
Form
. _ _ ___ •_ ..._ _. __ _. _ i v � r.� . . . __ _ _
�g N.W. FOURTH ST.. STE 500
Ciry,Smte,andZlPCade EVANSVILLE.
GREG WRIGHT
Seller 1� Name os appeurs on ronveyanre dxumen[
�X /� //
Address (h'umberund StreeQ
�P�zl�c ��ra��� �'+.l 4� 6 70
iry,
�
Company
Te/ephoneNum6er
�
Seller 2- Name as oppears om m�veyance dxvmen[
Addrea (Number and Sbee[J
Ciry.Smte,
E-mail
Under penalties of pery'ary, 1 hereby cer[ify [hat this Sales Disclosure, to the best of my knowledge and belief, is true, correc[
and �omple[e as required by law, and is prepared in accordance with IC 6-11-5.5, "Real Property Sales Disclosure Act".
Buyer I - Nome as
CiN Smtz and ZIP Code
� /' !
Telephone Num6er £-mail
TNE SALFS OISCLDSURE FORM MAV BE USED TO APPLY FOR CERTAI\ DEOIIGTIONS FOR
1'ES NO CONDITION
� 1. Will this property be the buyer's primary �
residence? Provide complete address of pr ary
res� en�e, incs fing county:
ress(Nombervnd5treelJ � �
/uil /N � 7�?�
CiN.Smce Cade Counry
� 2. Does [he buyer have a homes[ead in Indiana to be
vacated for this residence? Ifyes, provide
comple[e address of residence being vacated,
including county:
Signaareo(Seller
Buyer 2- Name as appeors an ronveyanae dacumen[
Addres(NumberandSveeQ
Ciry, Srnre, ond IIPCode
THOSE THAT APPLY.
� � 3. Homestead
� � 4. Solar Ener ea[ing/Cooling Sys[em
md Power Device
❑ � 6. Hydroelectric Power Device
❑ � 7. Geothermal Energy Heatlng/Cooling Device
� � 8. Is this property a residen[ial rental property?
❑ [� 9. Would you like [o receive taK statements for [his
proper[y via e-mail? (Provide contact informadon
below. Please see instructions for more infarmadon.
Not available in afl counties.J
Addreu (Num6er and StreetJ
�G - �a _ a �-.�o s� a�o. �s�a-c� �'
Ciry, Smte ZIPCode Counry
Pnmarypmperryoumermntu¢name E-mail
Under penal[ies of perj 1 here � certify that this Sales Disclosure, to the bes[ of my knowledge and belief, is true, correct
and complete as re r� y 1 ^ nd is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure AcC. (Note:
Spouse informatiq ,� al / �ty and Driver's License/Other numbers are no[ necessary if no Homestead Deduction is
being filed.) �
Yn L R NamPO(C17Yf1 ��
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LastSdigimafBuyer7Driver's Smte LastSDigiao%Socia(SecuriryNum6er
License/10/Other Number
Signamre oJBuyer2/Spouse
Pnnred Legal Name of By�a 2/Spoute
(MM/DD/VYYt]
LastSdigicso%Buyer2/SpouseDnver's Stace LastSDigirsojSocial5ecurity
A'um6er License/ID/OtherM1'umber
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