HomeMy WebLinkAboutHomestead_ThackerINDIANA SALES DISCLOSURE FORM SDF ID: 2012 Pa9e 2
D. PREPARER
Sherri S Hudson Closing AQent
Preparer of Ihe Sales Disdosure Form Tifle
605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Tiile
Address (NUmber and Stree7) Company
Evansville, Indiana 47713 (
E-mail
E. SELLER(S) / GRANTOR(S)
Michael R. Kelley
Sell=r 7- Name as appears on conveyance tlocumenf Seller 2- Name as appears on conveyance document
704 East Haub Street
Address (Number and Sfreef) Address (Numbei and Street)
Haubstadt, IN 47639
Gty, Sta7e, and ZIP Code City, State, and ZIP Code
hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and co�/�equired by law, and is prepared in accordance with IC 6•1.1-5.5, "Real Property Sales Disclosure AcY'.
Signature ol Sel(er , Signature of Seller
Michael R. Keliey �b^30'/2
Pnnted Name of Sellei Sign Date (MM/DD/YriY) Pnnfed Name oJ Selfe� Sign Da(e (MM/DD/YYYY)
F. BUYER(S)/GRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL ITEMS THAT APPLY
Karan A.Thacker
Buyer 7- Name as appears on conveyance document Buyer 2- Name as appears on conveyance documenf
204 S. Sth Ave.
Address (NUmber and StreetJ Address (NUm6er and Street)
Haubstadt, IN 47639
Ciry, Sfafe,
Telephone Number E-mail Telephone Number E-mail
THE SALES DISCLOSURE FORM MAV BE USED 70 APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION ES NO CONDITION
❑ 1. Will this propeRy be the buyer's primary ❑ 3. Homestead
residence? Provide complete address of primary p p q. Solar Energy Heating/Cooling System
residence, including couniy:
❑ � 5. Wind Power Device
704 East Haub Street
Address (Num6erand Street) ❑ 0 6. Hydroelectric Power Device
IHaubstadt, IN 47639 � Gibson � �� Geothermal Energy Heating/Cooling Device
ciy; Srate ziP code counry ❑ � 8. Is this property a residential rental property?
� � 2. Does the buyer have a homestead in Indiana to be � 0 9. Would you like to receive tax statements for this
vacated for this residence? If yes, provide complete property via-email? (Provide contact information
address of residence being vacated, including county: below. Please see instructions formore inlormation.
�p � S, G; p � �j„ Not available in all counties.)
-J'li�� Y!V
Address�NumberandStreet) ri�` IC�� 7,I—LI f�O_OM•�/ ��-y�L"1
�,,G�{�- .�- �( 7� 3� �'���bn� O( I/ TL l.�lJ (aJ —t�i/
Ciy,StateZlPCode County P�marypropertymvne�wntacfname 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 AcY'. (Note: Spouse
info�"} t-ion, Social Security and Driver's LicenselOther numbers are not necessary if no Homestead Deduction is being fled.)
�'�Lt�x !� �i��^LC�i..,ir��
Signature of Buyer 7 SignaN�e of Bvyer 2/Spouse
Karan A. Thacker l� I�D 1 � 3
Pnnt Legal Name of Buyer 7 Sign Date (MhNDDNYYY) Pnnt Legal Name oI Buyei 2/Spouse Sign Date (MM/DD/YYYV)
�
State Las15 Digits of Social5ecunty Nomber Last 5 digits of Buyer 2 Onvers Sfate Last 5 Digits of Social Secunry Number
LicensrJlD/Other Number License/ID/Ofher Num6er