Homestead_Burkhart (2)I
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INDIANA SALES DISCLOStIRE FnRM snr In:
D. PREPARER rage t
Attorney at Law
:reparer dJtne Safes Disdasvre Form T¢le
Conor O'Daniel, Esq. Foster, O'Daniel & Hambidge
Addreu (A'umber and Street) Company
3820 Oak Hill Rd.
Evansville, IN 47711 E -mad
E. SELLER(S)/GRANTOR(S)
Patricia Burkhart
Seller Name as appears on conveyance docummr
Seller2 Name as appears on con vryonce document
226 Madison St.
Address (Number and Street)
Address (Number and Street)
Oakland City, IN 47660
City, State, and ZIP code
Tel, hone Number Email
Telephone Number Email
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 Ja v,.and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ".
i \
Signature/Seller Agnotvre o /Seller
Patricia Burkhart 07 /2011
Printed Name o Seller Si n Date nsr DD Printed Name o Seller Si n Dale wst DD
F. BUYERS GRANTEE 5 - APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL ITEMS THAT APPLY
Jacob Burkhart
Bvver1 Nameasoppeors on conveyance document Buyer2 A 'omeasappearson,.a"yoncedocument
114 S. Jackson
Address (N'umber and Street) Address (Number and SVCet)
Oakland City, IN 47660
Ciry, State, and ZIP Code City. State, and ZIP Code
Email Telephone Number Email
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION I ITS NO CONDITION
❑ ❑ 1. Will this property be the buyer's primary
® ❑ 3. Homestead
residence? Provide complete address of primary
❑ EJ 4. Solar Energy Heating /Cooling System
residence, including county:
❑ ® S. Wind Power Device
❑ [td 6. Hydroelectric Power Device
Address (Number and Street)
E] ® 7. Geothermal Energy Heating /Cooling Device
State ZIP Code
County
❑ [� 2. Does the buyer have a homestead in Indiana to be
❑ ❑ 8. Is this property a residential rental property?
vacated for this residence? If yes, provide
❑ [ 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.)
Jacob
Address (Number and Street)
7�Burkhart /y� �"J� /�.
IQ r/
/ff- tia3.� l /3 - �J
City. Stare ZIP Code Covnry
•
Primary property owner contact name Email
Under penalties of perjury, l 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.)
A .ar,, at Boy"I Signature o/Bayer21Spouse
Jacob Burkhart 07/ 1( /2011
Last S digits of Buyer l Driver's State Last S Digits of5ociol Security Number Last S digitsofBvyer2 1Spouse Driver's State Last 5 Digits of5ocial Security
Licertse /ID /Other Number Number Licensell0l0ther Number
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