Homestead_PrayINDIANA SALES DISCLOSURE FORM SDF ID: 2012 � Page 2
D. PREPARER
Teresa Holifield Closing Agent
Preparero(the Sales Disclosure Form Title
605 SE Martin Luther King Jr Boulevard Southwestern Indiana Land Title
Address (Number and Street) Company
Indiana 47713
E. SELLER(S) I GRANTOR(S)
Jane G. Cunningham
Sel(er 7- Name a pears on c yance document Sel/er 2- Name as appears on carveyance document
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Adtlress Number and Stieet) Address (NUm6er and Street)
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GTy, State, and ZIP Code Gry, Sfate, and ZIP Code
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E-mail TelepAone Number 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".
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Signature oJ Seller
APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL ITEMS THAT APPLY
conveyance
a y m ano ou yq
iN r rr, e 1� � / l�/ `�'7� % D
E-mail
THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN
NO GONDITION
❑ 1. Will this property be the buyers primary
residence? Provide complete address of
residence, including county:
105 Rock Road
Address (Number and St2et/
,Owensville, IN 47665 Gibson
City, Stafe ZIP Cotle Counry
� `y 2. Does the buyer have a homestead in Indiana to be
�� vacated for this residence? If yes, provide complete
address of residence being vacated, inGuding county:
Buyer 2- Name as appears on conveyance document
Address (Num6er and Street)
Ciry, State, antl ZIP Code
ALl OF THOSE THAT APPLY.
❑ 3. Homestead
System
■ ��i/TiGI
❑ �' 6. Hydroeledric Power Device
❑ � 7. Geothermal Energy Heating/Cooling Device
❑ � 8. Is this property a residential rental property?
❑ �' 9. Would you like to receive tax statements for this
property via-email? (Provide confact information
below. Please see instiuctions (ormore information.
Not available in all counties.)
Adtlress (Num6er antl Street)
c�� ' /�-0 %/0/- �Od. 0?0 e� - �doZ
City, State ZIP Code County P�marypropertyownercontacf name Eanail
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
jnfortnation, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is being filed.)
aynamre w euyer � v �
Gregory D. Pray � � �/j'J
PAnf Legal N me o(Quxel7 Sign Da (M NYYY)
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Number
License/ID/Other Number
Signature of Buyer 2/Spouse
Pnnt Legal Name of Buyer 2/Spouse Sign Date (MM/DDNYri)
Last 5 digifs of Buyer 2 D6veYS State Last 5 Digits o/ Social Secunty Num6er
LicenSe//D/Ofh er Number