Homestead_TepovichINDIANA SALES DISCLOSURE FORM SDF ID: 2012 Pa�a �
D. PREPARER
.(
Sherri S. Hudson Closinq Agent �
Preparero/the Sa/es Oisclosure Form Title
605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
Add2ss (Number and Streery Company
Evansville, Indiana 47713 (
ephone fJUmber E-mail
E. SELLER�S) / GRANTOR(S)
Mae Louise Pollock
Seller i- Name as app a s on conveyance document Selier 2- Name as appears on conveyance document
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ddress (Nu r nd et) Address (Num6e� and Sfreet)
i� n�r� , ��l �7C 7lJ
Gty, State, and ZIP Code City, Stafe, antl ZIP Code
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' E-mail Telephone Num6er 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 Act".
���(is ��/"l/C.2¢ !-D'�re+L'�
Signature of Sel r Signature of Selle�
Mae Louise Pollock J a—/.2 �� �
Pnnted Name of Selle� Sign Date (MM/DD/YYYY) Pnnted Name of Seller Sign Dafe �MANDONYYY)
F. BU - APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL ITEMS THAT APPLY
Me an Lei h Te ovich
- �` nveyance tlocument Buyer 2- Name as appears on conveyance tlocument
O v
Address (NUm6e� and Streef) Address (Number and St2e[)
�rincP-F�on, TN `i7��0
E-mail Te/ephone Num6er E{nail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUC710N5 FOR THIS P TY. IDENTIFY ALL OF 7HOSE THA7 APPLY.
YES NO CONDITION NO CONDITION
� ❑ 1. Will this property be the buyels primary ❑ 3. Homeste
residence? Provide complete address of primary p p 4. Solar Energy Heating/Cooling System
residence, inGuding county:
❑ 0 5. Wind Power Device
907 South Jefferson Street
address (Numberand stree�) ❑ 0 6. Hydroelectric Power Device
Princeton, IN 47670 Gibson � a� Geothermal Energy Heating/Cooling Device
ciry, srate zia code counry ❑ 0 8. Is this property a residential rental property?
� � 2. Does lhe 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 infortna6on
address of residence being vacated, including county: 6elow. Please see instructions /ormore information.
- Not availa6le in all counties.)
Address (NUmber and Sfreet) �
� ..�a- �� /oi-DO3. 3�� -oa8
City,StafeZlPCode Covnty Pnmarypropertyownercontactname 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
infortnation, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is being £led.)
� a� is� ��.n�,rr�
Signatur /Buyer 1 �� 7 Signature of Buyer 2/Spouse
Megan Leigh Tepovich � 2�� Z'ZU �Z
Pnnt Legal Name
Number Last 5 digits o7 Buyer 2 Dnvers State Cast 5 Digits o/ Social Sewnty Num6er
LicenseJlD/Other Number License/ID/Ofher Number