HomeMy WebLinkAboutHomestead_SeilerINDIANA SALES DISCLOSURE FORM SDF ID: 2012 Page 2
D. PREPARER
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Preparer of the Sales Disclosure Form Title
605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
Address (Number and Street) Company
Evansville, Indiana 47713 (
Crty, State, and ZIP Code Telephone Number E-mail
E. SELLER(S) / GRANTOR(S)
Gregory K. Bane Stacey M. Bane
Seller 1- Name as appears on conveyance document Seller 2- Name as appears on conveyance document
706 E. Haub St. 706 E Haub St
Address (Number and Street) Address (Number and Street)
Haubstadt, IN 47639 Haubstadt, IN 47639
City, State, and ZIP Code City, State, and ZIP Code
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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 a cordance with IC 6-1 1-5.5, "Real Property Sales Disclosure AcY'.
1 �` �a� � r�J
Signature Signa ure of Sell r
Gregory K. Bane Stace M. Bane
Printed Name of Seller Sign Date (MM/OD/YYYY) Printed Name of Seller Sign ate (MM D/YYYY)
F. BUYER(S)/GRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL ITEMS THAT APPLY
Joshua S. Seiler Laura C. Seiler
Buyer 1- Name as appears on conveyance document Buyer 2- Name as appears on conveyance document
155 N. Center Road 155 N. Center Road
Address (Number and Street) Address (Number and Street)
Boonville, IN 47601 Boonville, IN 47601
City, State, and ZIP Code
E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.
YES NO CONDITION
❑ 1. Will this property be the buyer's primary ❑ 3. Homestead
residence? Provide complete address of primary p p 4. Solar Energy Heating/Cooling System
residence, including county:
❑ 0 5. Wind Power Device
706 East Haub Street
Address (Number and Street) ❑ 0 6. Hydroelectric Power Device
---- --- -- - - ❑ ❑ 7. Geothermat Energy Heating/Cooling Device
�Haubstadt IN 47639 Gibson�
City, State zlP Code Counry ❑ L�I 8. Is this property a residential rental property?
� � 2. Does the buyer have a homestead in Indiana to be � � 9• �Nould 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 for more information.
Not available in all counties.)
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Address (Number and Street) � / _ _' p_ "� ,_� O _ yyr�O � '7 / I _ b O
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g�� �� ( it� =/U y 7c�1 tA �'�� �%�� Primary property owner contact name � E-matl
City, State ZIP Code Counry
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
information, Social Security and Driver's License/Other numbers are not necessary if �o �m�stead�� n is being filed.)
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Sign ture of Buyer 1 Sig tur of Buyer 2/Spouse
Joshua S Seiler 11 i�v�7o�� Laura C Seiler � 1�� �a'
Print Legal Name of Buyer 1 Sign Date (M /DD/YYYY) Print Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YYYY)
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Security Number Last 5 digits of Buyer 2 Driver's State Last 5 Digits of Social Secunty Number
License/ID/Other Numbe� License/ID/Other Number