HomeMy WebLinkAboutHomestead_McEllhiney (10)LANA C. HARPER
heparer of the Svla Discloture Form
Addrw (Number and Stree[)
EVANSVILLE IN 47708
Ciry, Smce, and ZIPCade
DAVID J. TILLMAN
Self;r 1� Name as appmrs on ropveyanrt docvmmt
(Number
,o: �� ao�y-
�- - _ . �. .
Title
TOTAL TITLE SERVICES. LLC
Company
. E�mail
Seller2-A'ameasaypearsonconveyonredatumen[ '
Address (Num6er and Sveet)
Ciry.Smte. andZlP Lode
Under penal[ies of perjury, 1 hereby cer[ify that this Sales Disclosure, to the bes[ of my knowledge and belief, is true, correc[
an�complet �.requ�ed by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disdosure Act".
I
.�J
THE SALFS DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEOUCTIONS FOR THIS
�❑ 1. Will this property be the buyer's primary (
. residence? Provide complete address of prim�ry
II� �• r����inclyd)ngcounty: \
�r-
�'rl✓��p�rErYi�" l� `f%�7D 1h5�
�Ciry,SmreZ lade Covnry
�� 2. Does the buyer have a homes[ead in Indiana [o be
vacated for this residence? If yes, provide
complete address of residence being vacated,
including county:
Address (Number and Svee[J
Counry
5{qnamrea/Seller
Bu}rer2 - Name as appears on canveyanre
Addr� (Number and Sveet)
Ciry, Smte, ond ZIPCode
THAT APPLY.
❑ 3. Homestead�
�; 4. Solar Ener eating/Cooling System
-i' ' ^ G `"'�—'�Power Device
�-�-�._.,.�
❑ [�, 6. Hydroelectric Power Device
❑ 7. Geothermal Energy Heatlng/Cooling Device
� 8. Is this proper[y a residen[ial renfal property?
❑ 9. Would you like to receive cax sta[ements for this
property via e-mail? (Provide contact informadon
6elow. Please see instructions for more injormation.
Not available in all counties)
a�-ia-6�-ao� o�a.oi5� �a�
conmcename E-mail
Under penalties of perjury, i hereby certify [ha[ this Sales Disclosure, [o Ihe bes[ 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 AcY'. (Note:
Spouse information, Social Security and Driver's License/Other numbers are no[ necessary if no Homestead Deduc[ion is
beiqg filed.) ,
��r' `..�. � .a, i_ i � . . �
t
Sign Date (MN/OD/YYYY)
CastSdigi6o�Buyer]Driver"s Sfnte Las[SDigitsof5ocialSecurityNum6er
Litense/ID/Other Num6er
Signadre ofBuyv2/Spouse
Pnnad Legal Nome af Bvyer 2/Spoose
S19t1 DOtQ (HM/DD/YYYI]
6ast 5 digiu ojBuyer 2/Spause Oriver's Sm[e Las[ 5 Digia of5ocia15ecunry
Number Lirense/!D/OtherNumber .