HomeMy WebLinkAboutHomestead_Scott (3)I\DIA\A SALES DISCLOSGRE FOR�t SDF ID SDO iD 1388909 pape Z
D.PREPARER'
Lacey Pemberton Loan Processor
Preparcr o(rhe Soles 08rlosure Form Title
PO Box 126 Lynnville National Bank
Address (Numbcr oiM Street� Company
Lynnville, IN 47679-
E. SECLGR S GlL1NTOR S " -
GARY E UTLEY CONNIE SUE UTLEY
5¢ller 1- Nome as oppmrs on ronveynnce document Seller d-.vome os appears an cam�evance Aocument
12979 SANDERSAN DR 12919 SANDERSAN DR
Address (Number and SbectJ Address (NUmAer mJSVeet)
EVANSVILLE,IN 4772`r EVANSVILLE,IN 47725-
Ciry•. Smre, nnd ZIP lode Ciry, Smte, anAZIP Code
E-mvil
Under penalties of perjmy, I hereby certify that this Sales Disdosure, to the best of m}rknowledge and belie(; is hve, correct
an c iplete as requ�ired b(X law, and is prepared in accordance �+�th IC -1.1-S.S, "R 1 Property Sales Disclosw•e AcY'.
� VV! �i� `3 —�r' �'ix�� / � �_
- namreo(Sell � nofureo/Seller
�. �� �J - ' - -
F. QUYER S GRANTEE S- APPLIGATION FOR PROPERTY TAX DGDUCTIONS- IDENTIF}' ALL ITEh1S THAT APELY
DANIEL L SCOTT JR
Buyer 1- Name ns ap7mn on mmryonre dxumen: Bu�rr 2- Nnme ns uppears on ronvn•anre documenr
128 E 795 S
Addresz (Number ond Svert) Add¢n (Nnmber ond Sneet)
FORT BRANCH, IN 47648-
Te/e honeNumber E-mail Tele honeA'umber f-mail
TNE SALFS DISCLOSURE iORM MAl' BE USED TO APPLY FOR CERTAIN DEDUClIONS FOA THIS PROPERTY. IDE�TIFY ALL OF TNOSE THAT APPLI'.
YES NO CONDITION YES ND COYDITION
X❑ � 1. Will this property be the buyer's primary QX � 3. Homes[ead
residence? Provide comple[e address of primary � � 4. Solar Energy Hea[ing/Cooling System
residence,includingcounty: � �
128 E 795 S 5. Wind Po�ver Device
Addrn's(NumbrrandSbee[) ❑ Q 6. Hydroelec[ric Power Device
FORT BRANCH, IN 47648 GIBSON � � 7. Geothermal Energy Heating/Cooling Device
liry, Smte ZIPCode Counry
XQ � 2. Does the buyer have a homestead in Indiana to be � � $� �s this property a residential rental property?
vacaced for this residence? If yes, provide ❑ 0 9. Would you like to receive tax statemen[s for this
complete address of residence being vacated, property via e-mail? (Provide rontac[ information
inciuding cou nty: below. Please see instructions for more in(ormotion.
123 DOERNER RD Not available in all counties)
AdArar (A'umhe� ond Svre.)
LYNNVILLE, IN 47619 GIBSON � b � �p _' O_-Z6 3 �O i.� 5,5 -oa b
Ciry,SmteZlPCode CounN �--� �
Pnmary properry ownerconmc[ nome E-muil
Under penalties of perjury, t hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, mrrect
and complete as required by law, and is prepared in accordance with IC b-1.1-5.5, "Real Property Sales Disclosure AcY'. (No[e:
Spouse informadon, Social Secu i and Driver's License/Other numbers are not necessary if no Homestead Deduction is
bein �IedJ � }
a "�//�
amre af Buveq Signature o/�BUVer2/Spouse
� � � r 10 31-I�
Prin� � uycr 1 IN �
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Last 5 digiCSajBuyer 7 0�iver't 5[afe Los! S DiDi[s o�SodalSecurity Number Las[ S digiGS o/Boyer2/Spoute Driver's 5[n[e Las[ i Digi's o/Sociol Secun[r
License/ID/OtherNumber Number License/1D/OtherNumber
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